Provider Demographics
NPI:1417592569
Name:CRUTCHFIELD, LADONNA ANN
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:ANN
Last Name:CRUTCHFIELD
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 1:18284 JAMES COUZENS FWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2503
Mailing Address - Country:US
Mailing Address - Phone:313-646-6864
Mailing Address - Fax:
Practice Address - Street 1:18284 JAMES COUZENS FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2503
Practice Address - Country:US
Practice Address - Phone:313-646-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator