Provider Demographics
NPI:1992295141
Name:CRAWFORD, KEN R
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:R
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 7TH ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-5038
Mailing Address - Country:US
Mailing Address - Phone:651-774-9979
Mailing Address - Fax:651-774-9979
Practice Address - Street 1:733 7TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-5038
Practice Address - Country:US
Practice Address - Phone:651-774-9979
Practice Address - Fax:651-774-9979
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor