Provider Demographics
NPI:1134299639
Name:CRAWFORD, JENNIFER SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SUE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5001 N KINGS HWY
Mailing Address - Street 2:SUITE 205A
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-2556
Mailing Address - Country:US
Mailing Address - Phone:843-283-9700
Mailing Address - Fax:843-497-0551
Practice Address - Street 1:5001 N KINGS HWY
Practice Address - Street 2:SUITE 205A
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2556
Practice Address - Country:US
Practice Address - Phone:843-283-9700
Practice Address - Fax:843-497-0551
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1033103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist