Provider Demographics
NPI:1316560758
Name:CROZIER, JENNIFER LARKIN (LMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LARKIN
Last Name:CROZIER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 E MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3649
Mailing Address - Country:US
Mailing Address - Phone:217-621-8610
Mailing Address - Fax:
Practice Address - Street 1:44 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3649
Practice Address - Country:US
Practice Address - Phone:217-621-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227002366225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist