Healthcare Provider Details

I. General information

NPI: 1750057451
Provider Name (Legal Business Name): SANDRA MICHELLE CROWDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2021
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 NE 201 RD
LOWRY CITY MO
64763-9197
US

IV. Provider business mailing address

8588 N CEDAR CT
COLUMBIA MO
65202-6746
US

V. Phone/Fax

Practice location:
  • Phone: 660-492-5368
  • Fax:
Mailing address:
  • Phone: 166-049-2536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019040795
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: