Provider Demographics
NPI:1700129376
Name:CRAWFORD, JAMES (ICS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 N SHERMAN AVE # 323
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4236
Mailing Address - Country:US
Mailing Address - Phone:608-445-4886
Mailing Address - Fax:608-467-9135
Practice Address - Street 1:4222 MILWAUKEE ST STE 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-3534
Practice Address - Country:US
Practice Address - Phone:608-467-9134
Practice Address - Fax:608-467-9135
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14524-132101YA0400X
WI15371-135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)