MEDICARE: RUTH CROWELL

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	103K00000X	Behavior Analyst	1-07-3228	FL

General Provider Information

NPI Number	:	1427408509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH CROWELL

Provider Business Mailing Address
First Line	:	6659 HARBOUR BLVD
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-5579
Country	:	US
Telephone Number	:	850-819-2583
Fax Number	:	386-767-4319

Provider Business Practice Location Address
First Line	:	6659 HARBOUR BLVD
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-5579
Country	:	US
Telephone Number	:	850-819-2583
Fax Number	:	386-767-4319

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

Provider Enumeration Date	:	06/20/2016
Last Update Date	:	06/20/2016

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Directions to “ RUTH CROWELL ” Practice Location

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