1588655674 NPI number — MS. JANET ANN CROWLEY M.A.

Table of content: MS. JANET ANN CROWLEY M.A. (NPI 1588655674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588655674 NPI number — MS. JANET ANN CROWLEY M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROWLEY
Provider First Name:
JANET
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588655674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4944 LINDELL BLVD
Provider Second Line Business Mailing Address:
APT 5E
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63108-1534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-454-9416
Provider Business Mailing Address Fax Number:
314-647-3605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 CLAYTON RD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63117-1328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-647-3558
Provider Business Practice Location Address Fax Number:
314-647-3605
Provider Enumeration Date:
10/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY01383 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110036 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 291856 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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