Provider Demographics
NPI:1164036638
Name:KREWSON, REBECCA JANE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:KREWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15183 HIGHWAY C
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MO
Mailing Address - Zip Code:65541-9316
Mailing Address - Country:US
Mailing Address - Phone:573-201-5143
Mailing Address - Fax:
Practice Address - Street 1:15183 HIGHWAY C
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MO
Practice Address - Zip Code:65541-9316
Practice Address - Country:US
Practice Address - Phone:573-201-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health