Provider Demographics
NPI:1790283224
Name:CROW, BREANNE (PLADC)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:CROW
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5044
Mailing Address - Country:US
Mailing Address - Phone:402-379-3622
Mailing Address - Fax:402-644-4593
Practice Address - Street 1:910 W PARK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5044
Practice Address - Country:US
Practice Address - Phone:402-379-3622
Practice Address - Fax:402-644-4593
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1549101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)