=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225925142
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARITY E CROWE CSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2025
-----------------------------------------------------
Last Update Date | 06/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1704 W STOCKTON ST
-----------------------------------------------------
City | EDMONTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42129-8137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-432-4800
-----------------------------------------------------
Fax | 270-432-4804
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 645996
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45264-5996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-651-4263
-----------------------------------------------------
Fax | 270-659-5609
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 260195
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------