Provider Demographics
NPI:1588613624
Name:CROUCH, EDWARD D (MSW)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:D
Last Name:CROUCH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11334 19TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6550
Mailing Address - Country:US
Mailing Address - Phone:206-363-1432
Mailing Address - Fax:206-363-1432
Practice Address - Street 1:9500 ROOSEVELT WAY NE
Practice Address - Street 2:SUITE 206
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2252
Practice Address - Country:US
Practice Address - Phone:206-362-1114
Practice Address - Fax:206-363-1432
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000051951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA108377Medicare ID - Type Unspecified