Healthcare Provider Details

I. General information

NPI: 1215662861
Provider Name (Legal Business Name): JENNIFER CRABTREE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 NAPOLEON RD
MICHIGAN CENTER MI
49254-1259
US

IV. Provider business mailing address

349 NAPOLEON RD
MICHIGAN CENTER MI
49254-1259
US

V. Phone/Fax

Practice location:
  • Phone: 517-513-4802
  • Fax:
Mailing address:
  • Phone: 517-513-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6801098848
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: