1255520144 NPI number — MRS. JANICE J CRAWFORD MS.CCC/SLP

Table of content: MRS. JANICE J CRAWFORD MS.CCC/SLP (NPI 1255520144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255520144 NPI number — MRS. JANICE J CRAWFORD MS.CCC/SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAWFORD
Provider First Name:
JANICE
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS.CCC/SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255520144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14534 N ASTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDENDALE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79758-4720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-631-8162
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 TOWER DR
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79761-4239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-335-8777
Provider Business Practice Location Address Fax Number:
432-335-8787
Provider Enumeration Date:
10/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  24554 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 24554 . This is a "TEXAS LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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