Basic Information
| Provider Information | |||||||||
| NPI: | 1396211850 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROZIER | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2303 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645064954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162326818 | ||||||||
| FaxNumber: | 8162326823 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 CROSS ST | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 646448311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165832713 | ||||||||
| FaxNumber: | 8165832342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2018 | ||||||||
| LastUpdateDate: | 07/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 099140 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 2014036219 | MO | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 2019030408 | MO | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 490064726 | 05 | MO | MEDICAID |