Healthcare Provider Details

I. General information

NPI: 1417732595
Provider Name (Legal Business Name): MARY CREWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MONROE ST STE 204
TOLEDO OH
43623-3467
US

IV. Provider business mailing address

5151 MONROE ST STE 204
TOLEDO OH
43623-3467
US

V. Phone/Fax

Practice location:
  • Phone: 419-865-5690
  • Fax:
Mailing address:
  • Phone: 419-865-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2608441
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: