Provider Demographics
NPI:1972938173
Name:CRAHAN, JENNIFER M (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:CRAHAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 32ND ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7099
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:1202 COUNTY ROAD PH
Practice Address - Street 2:STE 100
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8440
Practice Address - Country:US
Practice Address - Phone:608-781-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021040225100000X
WI12394-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist