Provider Demographics
NPI:1922743053
Name:CRAWFORD, SHELLEY N
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:N
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 PARK PLACE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT EDEN
Mailing Address - State:KY
Mailing Address - Zip Code:40046-8043
Mailing Address - Country:US
Mailing Address - Phone:502-407-4382
Mailing Address - Fax:
Practice Address - Street 1:1017 DUPONT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-365-4467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY74911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical