Healthcare Provider Details

I. General information

NPI: 1255444311
Provider Name (Legal Business Name): KAREN DENESE TAYLOR-CRAWFORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN D CRAWFORD MD

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 TECHNOLOGY DR NE
WILLMAR MN
56201-2275
US

IV. Provider business mailing address

3208 W LAKE ST # 23
MINNEAPOLIS MN
55416-4512
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-5421
  • Fax: 320-231-5901
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036056639
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number61895
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: