Provider Demographics
NPI:1578033528
Name:CRAWFORD, DIANNA LYNN (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:LYNN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WYNDTREE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49037-7475
Mailing Address - Country:US
Mailing Address - Phone:269-967-7202
Mailing Address - Fax:
Practice Address - Street 1:1090 N 10TH ST STE 110
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5733
Practice Address - Country:US
Practice Address - Phone:269-375-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010987781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical