Crockrell, Jerry

Crockrell, Jerry is an individual health care provider with primary practice located at 411 W Division St , Manteno IL 60950-1065. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Crockrell, Jerry can be contacted via phone (815) 432-5241.

Contact Information

Primary practice address
411 W Division St Manteno IL 60950-1065
Phone: (815) 432-5241
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X

Profile Details

NPI number 1245799378
LBN Legal business name Crockrell, Jerry
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 18th, 2019
Last updated Mar 17th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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