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General NPI Number Information
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NPI Number | 1174652457
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Entity Type | Individual
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Provider Name | MARTHA CROTTS
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 06/01/2020
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Provider Practice Location Address
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Address Line | 5758 ELAINE DR
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City | ROCKFORD
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State | IL
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Zip | 61108-3102
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Country | US
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Telephone | 815-395-1008
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Fax |
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Provider Business Mailing Address
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Address Line | 4525 N RAVENSWOOD AVE STE 201
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City | CHICAGO
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State | IL
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Zip | 60640-5201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 036-088318
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License Number State | IL
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