Individual
MS. JACQUELINE JANETTE CRAWFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
1010 32ND AVE S, MOORHEAD, MN 56560-5001
(218) 233-7524
(218) 233-8627
Mailing address
PO BOX 10265, FARGO, ND 58106-0265
(218) 233-7524
(218) 233-8627
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
MN 2508
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1010730
PREFERRED ONE
MN
01
—
116409
UCARE
MN
01
—
62-24810
UBH
MN
01
—
7H222CR
BLUE CROSS BLUE SHIELD MN
MN
01
—
HP23073
HEALTHPARTNERS
MN
Enumeration date
06/22/2006
Last updated
07/09/2007
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