Healthcare Provider Details

I. General information

NPI: 1477154706
Provider Name (Legal Business Name): KAYLA CRAWFORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10640 BUSINESS 21
HILLSBORO MO
63050-5039
US

IV. Provider business mailing address

337 SAINT LOUIS ST
HERCULANEUM MO
63048-1110
US

V. Phone/Fax

Practice location:
  • Phone: 618-877-4420
  • Fax:
Mailing address:
  • Phone: 314-378-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2020012256
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024004102
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: