Provider Demographics
NPI:1710101522
Name:BOWEN-CRAWFORD, THERESA EVELYN (LW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:EVELYN
Last Name:BOWEN-CRAWFORD
Suffix:
Gender:F
Credentials:LW
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:E
Other - Last Name:BOWEN-CRAWFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LW
Mailing Address - Street 1:PO BOX 7853
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98417-0853
Mailing Address - Country:US
Mailing Address - Phone:253-680-9031
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:608 S G ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4625
Practice Address - Country:US
Practice Address - Phone:253-680-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601635771041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical