MEDICARE: JESSIE JUENE 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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1710811567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE JUENE CROWDER

Provider Business Mailing Address
First Line	:	400 CROSSINGS DR
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32413-2892
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8317 FRONT BEACH RD
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-4885
Country	:	US
Telephone Number	:	850-890-3994
Fax Number	:

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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