Healthcare Provider Details

I. General information

NPI: 1235067323
Provider Name (Legal Business Name): JERILYNN H CROWDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 ENERGY LN STE 109
SAINT PAUL MN
55108-5254
US

IV. Provider business mailing address

1350 ENERGY LN STE 109
SAINT PAUL MN
55108-5254
US

V. Phone/Fax

Practice location:
  • Phone: 651-269-2760
  • Fax: 651-340-6107
Mailing address:
  • Phone: 651-269-2760
  • Fax: 651-340-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: