Provider Demographics
NPI:1619544244
Name:S. KELLY CRANE, LLC
Entity Type:Organization
Organization Name:S. KELLY CRANE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-357-4327
Mailing Address - Street 1:PO BOX 21424
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0408
Mailing Address - Country:US
Mailing Address - Phone:541-357-4327
Mailing Address - Fax:
Practice Address - Street 1:1355 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3955
Practice Address - Country:US
Practice Address - Phone:541-357-4327
Practice Address - Fax:542-636-3607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty