MEDICARE: JESSE M CROWDER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.162220	OH
2	104100000X	Social Worker	S.2106128	OH
3	1041C0700X	Clinical Social Worker	I.2304984-SUPV	OH

General Provider Information

NPI Number	:	1417458134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE M CROWDER

Provider Business Mailing Address
First Line	:	815 SUPERIOR AVE E STE 1618
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2709
Country	:	US
Telephone Number	:	440-679-1452
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 SUPERIOR AVE E STE 1618
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2709
Country	:	US
Telephone Number	:	440-679-1452
Fax Number	:

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

Provider Enumeration Date	:	02/27/2018
Last Update Date	:	06/21/2025

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Directions to “ JESSE M CROWDER ” Practice Location

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