Healthcare Provider Details

I. General information

NPI: 1750964474
Provider Name (Legal Business Name): SHEVONDA CAROL CROWDER LSW,LMSW, SSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 S MATTIS AVE APT 101
CHAMPAIGN IL
61821-5902
US

IV. Provider business mailing address

1917 S MATTIS AVE APT 101
CHAMPAIGN IL
61821-5902
US

V. Phone/Fax

Practice location:
  • Phone: 618-305-4375
  • Fax:
Mailing address:
  • Phone: 618-305-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0903004832
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15037
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33013613A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150116256
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2018006519
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number63543
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number35837
License Number StateMN
# 8
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLM25656
License Number StateME
# 9
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number16597
License Number StateTN
# 10
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2467363
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: