MEDICARE: MS. MELISSA CRAWFORD LCSW

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	1041C0700X	Clinical Social Worker	CSW.09925347	CO

General Provider Information

NPI Number	:	1235691551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA CRAWFORD LCSW

Provider Business Mailing Address
First Line	:	1475 CHESHAM CIR
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80907-8623
Country	:	US
Telephone Number	:	571-224-8289
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 CHESHAM CIR
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80907-8623
Country	:	US
Telephone Number	:	571-224-8289
Fax Number	:

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

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	04/04/2019

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