Provider Demographics
NPI:1457488603
Name:CRAWFORD, MEGHAN DIANE (PSYD)
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:DIANE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5457 ROGUE RIVER HWY
Mailing Address - Street 2:
Mailing Address - City:GOLD HILL
Mailing Address - State:OR
Mailing Address - Zip Code:97525-6780
Mailing Address - Country:US
Mailing Address - Phone:626-888-1463
Mailing Address - Fax:503-974-0936
Practice Address - Street 1:5457 ROGUE RIVER HWY
Practice Address - Street 2:
Practice Address - City:GOLD HILL
Practice Address - State:OR
Practice Address - Zip Code:97525-6780
Practice Address - Country:US
Practice Address - Phone:626-888-1463
Practice Address - Fax:503-974-0936
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24764103T00000X
OR2409103T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program