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General NPI Number Information
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NPI Number | 1750964474
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Entity Type | Individual
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Provider Name | SHEVONDA CAROL CROWDER LSW,LMSW, SSW
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Gender | Female
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 1709 10TH ST APT A
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City | CHARLESTON
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State | IL
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Zip | 61920-2873
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Country | US
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Telephone | 618-305-4375
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Fax |
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Provider Business Mailing Address
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Address Line | 1159 LEAR LN
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City | MASCOUTAH
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State | IL
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Zip | 62258-2866
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Country | US
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Telephone | 618-305-4375
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 63543
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2018006519
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 2467363
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150116256
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License Number State | IL
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