Provider Demographics
NPI:1902781388
Name:CRUTCHER, DEJAH GABRIELLE
Entity type:Individual
Prefix:
First Name:DEJAH
Middle Name:GABRIELLE
Last Name:CRUTCHER
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 1:3940 LANCASTER LN N APT 232
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-1752
Mailing Address - Country:US
Mailing Address - Phone:763-203-4920
Mailing Address - Fax:
Practice Address - Street 1:2812 FAIRVIEW AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1308
Practice Address - Country:US
Practice Address - Phone:651-383-1048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician