Provider Demographics
NPI:1932637113
Name:CRAWFORD, JENNIFER ELIABETH (CLC, CD, NCS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIABETH
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:CLC, CD, NCS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:ACUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:5519 REIGER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-5041
Mailing Address - Country:US
Mailing Address - Phone:760-401-3735
Mailing Address - Fax:
Practice Address - Street 1:3100 SWISS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6025
Practice Address - Country:US
Practice Address - Phone:469-291-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
TX99485176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174H00000XOther Service ProvidersHealth Educator