Provider Demographics
NPI:1871349191
Name:FRANTZEN-CRAWFORD, ALEXIS MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:FRANTZEN-CRAWFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:FRANTZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:121 N MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-7619
Mailing Address - Country:US
Mailing Address - Phone:309-204-6260
Mailing Address - Fax:
Practice Address - Street 1:121 N MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-7619
Practice Address - Country:US
Practice Address - Phone:309-204-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0232031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical