Healthcare Provider Details

I. General information

NPI: 1144439290
Provider Name (Legal Business Name): RENA CRAWFORD CDA, MHPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W TYLER AVE
WEST MEMPHIS AR
72301-4149
US

IV. Provider business mailing address

635 S 10TH ST
WEST MEMPHIS AR
72301-5411
US

V. Phone/Fax

Practice location:
  • Phone: 870-733-1200
  • Fax:
Mailing address:
  • Phone: 870-735-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: