Provider Demographics
NPI:1689237513
Name:CRAWFORD, BRANDYE (PSS, CPRM-DP)
Entity Type:Individual
Prefix:MS
First Name:BRANDYE
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PSS, CPRM-DP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 E MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-5201
Mailing Address - Country:US
Mailing Address - Phone:313-506-7973
Mailing Address - Fax:
Practice Address - Street 1:4875 COPLIN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2192
Practice Address - Country:US
Practice Address - Phone:313-822-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist