Provider Demographics
NPI:1497107445
Name:CROUTERFIELD, JERI LYNN (MSW, LLMSW, CAADC)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:LYNN
Last Name:CROUTERFIELD
Suffix:
Gender:F
Credentials:MSW, LLMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5908 STURGEON AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-3237
Mailing Address - Country:US
Mailing Address - Phone:989-495-3075
Mailing Address - Fax:
Practice Address - Street 1:133 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-3350
Practice Address - Country:US
Practice Address - Phone:989-631-0241
Practice Address - Fax:989-631-0242
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-03651101YA0400X
MI68010995751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)