Individual provider Active NPI

Brenda Charece Crawford, PHD

  • Psychologist
  • Sioux City, IA
National Provider Identifier
1205188091
Registry record updated Oct 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
001059 Issued in IA
Practice address
2601 Apache Court
Sioux City, IA 51104-1594
Phone
(712) 239-1111
Fax
(712) 239-1199
NPI assigned
Oct 4, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 4, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 001059 IA Primary

Addresses

Primary practice location

2601 Apache Court
Sioux City, IA 51104-1594

Mailing address

2601 Apache Court
Sioux City, IA 51104-1594
Phone (712) 239-1111

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)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
001059IAMDHearing Instrument Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
C3, Inc CurrentSince Jul 25, 2021 Accepting new patients

Locations

2601 Apache Ct
Sioux City, IA 51104
Phone (712) 239-1111

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": "1349308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349308800000",
    "number": "1205188091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 APACHE COURT",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511041594",
            "telephone_number": "712-239-1111",
            "fax_number": "712-239-1199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 APACHE COURT",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511041594",
            "telephone_number": "712-239-1111",
            "fax_number": "712-239-1199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAWFORD",
        "first_name": "BRENDA",
        "middle_name": "CHARECE",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-04",
        "last_updated": "2012-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IA",
            "license": "001059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.