Active NPI
Connie Phillips Crowder, LCSW
- Clinical Social Worker
- Burlington, WI
National Provider Identifier
1003825142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2629-123
- Practice address
- 565 Milwaukee Ave
Suite 3C
Burlington, WI 53105-1254 - Phone
- (262) 757-0016
- Fax
- (262) 757-0018
- NPI assigned
- Aug 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2629-123 | WI | Primary |
Addresses
Primary practice location
565 Milwaukee Ave
Suite 3C
Burlington, WI 53105-1254
Mailing address
565 Milwaukee Ave
Suite 3C
Burlington, WI 53105-1254
Phone (262) 757-0016
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39189100 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2629-123 | WI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Burlington Behavioral Health, LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292803200000",
"number": "1003825142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "565 MILWAUKEE AVE",
"address_2": "SUITE 3C",
"city": "BURLINGTON",
"state": "WI",
"postal_code": "531051254",
"telephone_number": "262-757-0016",
"fax_number": "262-757-0018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "565 MILWAUKEE AVE",
"address_2": "SUITE 3C",
"city": "BURLINGTON",
"state": "WI",
"postal_code": "531051254",
"telephone_number": "262-757-0016",
"fax_number": "262-757-0018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROWDER",
"first_name": "CONNIE",
"middle_name": "PHILLIPS",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-07",
"last_updated": "2010-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "2629-123",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39189100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.