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NPI Code Detail

MEDICARE: AIMEE J CRASK MS, LCPC

MEDICARE: AIMEE J CRASK MS, LCPC
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
1174400000XSpecialist180005810IL
2101YP2500XProfessional Counselor180005810IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1180005810OTHERILLICENSED CLINICAL PROFESSIONAL COUNSELOR

General Provider Information

NPI Number : 1831526425
Entity Type Code : Individual
Provider Name (Legal Business Name) : AIMEE J CRASK MS, LCPC
Provider Business Mailing Address
First Line : 1942 E CANTRELL ST
Second Line :
City : DECATUR
State : IL
Zip : 62521-3214
Country : US
Telephone Number : 217-423-6961
Fax Number : 217-421-6889
Provider Business Practice Location Address
First Line : 1942 E CANTRELL ST
Second Line :
City : DECATUR
State : IL
Zip : 62521-3214
Country : US
Telephone Number : 217-423-6961
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2013
Last Update Date : 11/17/2022

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