MEDICARE: MS. JONI MARIE 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	3472	LA

General Provider Information

NPI Number	:	1750392593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JONI MARIE CRAWFORD LCSW

Provider Business Mailing Address
First Line	:	2285 BENTON RD
Second Line	:	SUITE 101-A
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-7933
Country	:	US
Telephone Number	:	318-746-5775
Fax Number	:	318-746-5787

Provider Business Practice Location Address
First Line	:	2285 BENTON RD
Second Line	:	SUITE 101-A
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-7933
Country	:	US
Telephone Number	:	318-746-5775
Fax Number	:	318-746-5787

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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