Provider Demographics
NPI:1467075762
Name:CRAWFORD, YOLANDE J (CERT HAIRLOSS SPECIA)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDE
Middle Name:J
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:CERT HAIRLOSS SPECIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1455
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-9255
Mailing Address - Country:US
Mailing Address - Phone:314-265-1910
Mailing Address - Fax:
Practice Address - Street 1:15 WINTER HILL CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-3961
Practice Address - Country:US
Practice Address - Phone:314-265-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO224P00000X, 1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist