MEDICARE: DR. WANDA J. CREWS

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	103TC0700X	Clinical Psychologist	PS003078L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	534468	OTHER	PA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1306972906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WANDA J. CREWS

Provider Business Mailing Address
First Line	:	870 LENAPE RD
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-2143
Country	:	US
Telephone Number	:	610-357-7474
Fax Number	:

Provider Business Practice Location Address
First Line	:	870 LENAPE RD
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-2143
Country	:	US
Telephone Number	:	610-357-7474
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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