Healthcare Provider Details

I. General information

NPI: 1306433537
Provider Name (Legal Business Name): ALEXANDRIA CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 GEORGE ST
NEW HAVEN CT
06511-6617
US

IV. Provider business mailing address

904 E MARTIN LUTHER KING DR
CENTRALIA IL
62801
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2540
  • Fax:
Mailing address:
  • Phone: 161-853-3139
  • Fax: 618-533-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: