Healthcare Provider Details

I. General information

NPI: 1578033528
Provider Name (Legal Business Name): DIANNA LYNN CRAWFORD LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 N 10TH ST STE 110
KALAMAZOO MI
49009-5733
US

IV. Provider business mailing address

57 WYNDTREE DR
SPRINGFIELD MI
49037-7475
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-4363
  • Fax:
Mailing address:
  • Phone: 269-967-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801098778
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: