Healthcare Provider Details

I. General information

NPI: 1750977245
Provider Name (Legal Business Name): JOURDAN CRUMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26067 REGENCY CLUB DR
WARREN MI
48089-6235
US

IV. Provider business mailing address

26067 REGENCY CLUB DR APT 8
WARREN MI
48089-6235
US

V. Phone/Fax

Practice location:
  • Phone: 248-791-8024
  • Fax:
Mailing address:
  • Phone: 248-791-8024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: