Provider Demographics
NPI:1437883840
Name:CROWELL, AMILY ROSE (LADC)
Entity type:Individual
Prefix:MRS
First Name:AMILY
Middle Name:ROSE
Last Name:CROWELL
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:AMILY
Other - Middle Name:ROSE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:111 COY ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4609
Mailing Address - Country:US
Mailing Address - Phone:651-308-2900
Mailing Address - Fax:
Practice Address - Street 1:802 S FRONT ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-2401
Practice Address - Country:US
Practice Address - Phone:651-308-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306364101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)