Provider Demographics
NPI:1952425043
Name:CRAWFORD, HERTA AUDREY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HERTA
Middle Name:AUDREY
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E 1200 S
Mailing Address - Street 2:STE 101
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6972
Mailing Address - Country:US
Mailing Address - Phone:801-310-0849
Mailing Address - Fax:801-221-0755
Practice Address - Street 1:313 E 1200 S
Practice Address - Street 2:STE 101
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6972
Practice Address - Country:US
Practice Address - Phone:801-310-0849
Practice Address - Fax:801-221-0755
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140057-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical