Provider Demographics
NPI:1770676207
Name:CRAWFORD, MARTHA JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JANE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 E VINE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995
Mailing Address - Country:US
Mailing Address - Phone:918-658-2611
Mailing Address - Fax:618-658-2759
Practice Address - Street 1:408 E VINE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995
Practice Address - Country:US
Practice Address - Phone:918-658-2611
Practice Address - Fax:618-658-2759
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical