MEDICARE: JAMIERA CRUSOE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst		AL

General Provider Information

NPI Number	:	1205621828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIERA CRUSOE

Provider Business Mailing Address
First Line	:	3610 MERRIFIELD DR
Second Line	:
City	:	VALLEY GRANDE
State	:	AL
Zip	:	36703-2723
Country	:	US
Telephone Number	:	334-419-0908
Fax Number	:	334-419-0908

Provider Business Practice Location Address
First Line	:	3610 MERRIFIELD DR
Second Line	:
City	:	VALLEY GRANDE
State	:	AL
Zip	:	36703-2723
Country	:	US
Telephone Number	:	334-419-0908
Fax Number	:	334-419-0908

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	04/14/2025

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Directions to “ JAMIERA CRUSOE ” Practice Location

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