Healthcare Provider Details

I. General information

NPI: 1780420406
Provider Name (Legal Business Name): JESSICA CREW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8261 MARKET ST
BOARDMAN OH
44512-6254
US

IV. Provider business mailing address

8261 MARKET ST
BOARDMAN OH
44512-6254
US

V. Phone/Fax

Practice location:
  • Phone: 330-286-0050
  • Fax:
Mailing address:
  • Phone: 330-286-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.193875
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2504397-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: