Provider Demographics
NPI:1740835750
Name:CRANDALL, REBECCA (LISW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:MONTVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, LISW
Mailing Address - Street 1:1408 INGERSOLL RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-6048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:604 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-4708
Practice Address - Country:US
Practice Address - Phone:833-370-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095348104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker