Provider Demographics
NPI:1144074196
Name:CROWLEY, TAYLOR JADE GRIDER (LMSW, BCBA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JADE GRIDER
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:LMSW, BCBA
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:JADE
Other - Last Name:GRIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:507 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2205 E GRANTVIEW DR
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-3406
Practice Address - Country:US
Practice Address - Phone:319-294-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-24-72397103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst