Provider Demographics
NPI:1518293299
Name:CRAWFORD, JUSTINA NOEL (MT-BC)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:NOEL
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 N WIELAND ST
Mailing Address - Street 2:1R
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1514 N WIELAND ST
Practice Address - Street 2:1R
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1267
Practice Address - Country:US
Practice Address - Phone:740-317-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL08463225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist