Provider Demographics
NPI:1932637113
Name:CRAWFORD, JENNIFER ELIABETH (LM, CPM, CLC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIABETH
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LM, CPM, CLC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:ACUNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:4612 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4612 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1010
Practice Address - Country:US
Practice Address - Phone:214-699-8659
Practice Address - Fax:817-612-3453
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99485176B00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174H00000XOther Service ProvidersHealth Educator