Individual ProviderTaresa Dawn CrowSocial WorkerBehavioral Health & Social Service ProvidersPractice Address3655 Samuel St, Ammon, ID 83406-7822(208) 403-7762PECOS EnrollmentBased on the most recent information from CMS, provider Taresa Dawn Crow does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1922627314Provider TypeIndividualFull NameCrow, Taresa DawnGenderFemaleSole ProprietorYesEnumeration Date4/15/2020Last Updated4/15/2020Contact InformationPractice LocationPractice Address3655 Samuel St, Ammon, ID 83406-7822Phone(208) 403-7762FaxUnlisted FaxMailing LocationMailing Address3655 Samuel St, Ammon, ID 83406-7822Phone(208) 403-7762FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense29530Idaho