Provider Demographics
NPI:1689341018
Name:CRAWFORD, TERRY WAYNE (CPS)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:WAYNE
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 INTERNATIONAL LN STE 205
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3152
Mailing Address - Country:US
Mailing Address - Phone:608-241-4285
Mailing Address - Fax:608-241-4286
Practice Address - Street 1:2801 INTERNATIONAL LN STE 205
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3152
Practice Address - Country:US
Practice Address - Phone:608-241-4285
Practice Address - Fax:608-241-4286
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12418175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700129376Medicaid