Provider Demographics
NPI:1265707137
Name:CROWDER, EMILY GUSTAFSON (EDS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GUSTAFSON
Last Name:CROWDER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1405
Mailing Address - Country:US
Mailing Address - Phone:864-205-8587
Mailing Address - Fax:
Practice Address - Street 1:16 GEORGE ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1405
Practice Address - Country:US
Practice Address - Phone:864-205-8587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5722101YP2500X
VT068.0134165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional