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Individual
JEANNE V CROCKETT
Active
Individual
JEANNE V CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
S27688
TX
1041C0700X
Clinical Social Worker
Primary
S27688
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071171502
—
TX
05
—
071171503
—
TX
05
—
071171504
—
TX
01
—
87607Q
BCBS TX PROVIDER#
TX
Enumeration date
12/18/2006
Last updated
01/19/2011
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