Provider Demographics
NPI:1770531584
Name:CROWDER, DONALD JERALD (MSW, LSCSW)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JERALD
Last Name:CROWDER
Suffix:
Gender:M
Credentials:MSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 SW BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4875
Mailing Address - Country:US
Mailing Address - Phone:800-785-2316
Mailing Address - Fax:
Practice Address - Street 1:5040 SW 28TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2302
Practice Address - Country:US
Practice Address - Phone:800-785-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100386950BMedicaid
KSP25093Medicare UPIN
KS100386950BMedicaid