Provider Demographics
NPI:1952918633
Name:CROWOLL, JONQUIL
Entity type:Individual
Prefix:
First Name:JONQUIL
Middle Name:
Last Name:CROWOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 NW 120TH WAY
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2638
Mailing Address - Country:US
Mailing Address - Phone:754-218-7582
Mailing Address - Fax:
Practice Address - Street 1:2510 NE 3RD AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3845
Practice Address - Country:US
Practice Address - Phone:754-215-6634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health