Provider Demographics
NPI:1417458134
Name:CROWDER, JESSE M
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:M
Last Name:CROWDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 SUPERIOR AVE E STE 1618
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2709
Mailing Address - Country:US
Mailing Address - Phone:440-679-1452
Mailing Address - Fax:
Practice Address - Street 1:815 SUPERIOR AVE E STE 1618
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2709
Practice Address - Country:US
Practice Address - Phone:440-679-1452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162220101YA0400X
OHS.2106128104100000X
OHI.2304984-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker