Shevonda Carol Crowder, LSW,LMSW, SSW
Individual provider Active NPI Social Worker · Charleston, IL
NPI 1750964474 · NPPES record last updated Feb 12, 2025
Key facts
- NPI
- 1750964474
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 150116256 (IL)
- Practice address
- 1709 10TH St Apt a
Charleston, IL 61920-2873 - Phone
- (618) 305-4375
- NPI assigned
- Apr 30, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150116256 | IL | MD | Social Worker |
| 2018006519 | MO | MD | Social Worker |
| 2467363 | IL | MD | School Social Worker |
| 63543 | TX | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 63543 | TX | |
| Social Worker | 104100000X | 2018006519 | MO | |
| School Social Worker | 1041S0200X | 2467363 | IL | |
| Social Worker | 104100000X | 150116256 | IL | Yes |
Addresses
Primary practice location
1709 10TH St Apt a
Charleston, IL 61920-2873
Mailing address
1159 Lear LN
Mascoutah, IL 62258-2866
Phone (618) 305-4375
Other providers in Charleston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.