Provider Demographics
NPI:1710124979
Name:CRISPIN, THERESA ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANN
Last Name:CRISPIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7422 ROSELAND DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4159
Mailing Address - Country:US
Mailing Address - Phone:515-224-0457
Mailing Address - Fax:
Practice Address - Street 1:7422 ROSELAND DR
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4159
Practice Address - Country:US
Practice Address - Phone:515-224-0457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03130104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker