Healthcare Provider Details

I. General information

NPI: 1538907803
Provider Name (Legal Business Name): GRACE CROWCROFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 S GRAND BLVD STE 224
SAINT LOUIS MO
63118-1047
US

IV. Provider business mailing address

4033 DELOR ST
SAINT LOUIS MO
63116-3362
US

V. Phone/Fax

Practice location:
  • Phone: 314-312-2357
  • Fax:
Mailing address:
  • Phone: 331-425-9504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2024027408
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: