Healthcare Provider Details

I. General information

NPI: 1255244190
Provider Name (Legal Business Name): DESIREE JO AN CROWLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CRAB ORCHARD RD
SOMERSET KY
42503-1349
US

IV. Provider business mailing address

411 CRAB ORCHARD RD
SOMERSET KY
42503-1349
US

V. Phone/Fax

Practice location:
  • Phone: 606-485-4673
  • Fax: 606-485-4600
Mailing address:
  • Phone: 606-485-4673
  • Fax: 606-485-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001799
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: