Provider Demographics
NPI:1255444311
Name:TAYLOR-CRAWFORD, KAREN DENESE (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DENESE
Last Name:TAYLOR-CRAWFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:D
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3208 W LAKE ST # 23
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 TECHNOLOGY DR NE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-2275
Practice Address - Country:US
Practice Address - Phone:320-231-5421
Practice Address - Fax:320-231-5901
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360566392084P0804X
MN618952084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61895OtherSTATE LICENSING BOARD
ILK16215Medicare PIN
MN61895OtherSTATE LICENSING BOARD