Healthcare Provider Details

I. General information

NPI: 1245952423
Provider Name (Legal Business Name): ELEANOR CRESCENZI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 SCHOOLHOUSE LN
SHADY COVE OR
97539-9500
US

IV. Provider business mailing address

1221 DISK DR
MEDFORD OR
97501-6638
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-3863
  • Fax:
Mailing address:
  • Phone: 541-773-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberA14495
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: