Provider Demographics
NPI:1194940254
Name:CROWSON, JOANNE WEIDEL (AUD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:WEIDEL
Last Name:CROWSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:JOANNE
Other - Middle Name:ELIZABETH
Other - Last Name:WEIDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1 ATWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1394
Mailing Address - Country:US
Mailing Address - Phone:800-227-7399
Mailing Address - Fax:
Practice Address - Street 1:1 ATWELL ROAD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1394
Practice Address - Country:US
Practice Address - Phone:800-227-7399
Practice Address - Fax:607-547-6552
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA 01234231H00000X, 237700000X, 237600000X
OHSP 4338235Z00000X
NY002257-1231H00000X
NY019122-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000002218976OtherANTHEM GROUP #
OH0510772Medicaid
OH000000440564OtherANTHEM INDIVIDUAL #
OH0000002218976OtherANTHEM GROUP #
OH000000440564OtherANTHEM INDIVIDUAL #