1679815955 NPI number — MRS. LAURA ANN CRAINE M.S., CCC-SP

Table of content: MRS. LAURA ANN CRAINE M.S., CCC-SP (NPI 1679815955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679815955 NPI number — MRS. LAURA ANN CRAINE M.S., CCC-SP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAINE
Provider First Name:
LAURA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SP
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:
1679815955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1085 TASMAN DR #675
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYVALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94089-5774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-910-9374
Provider Business Mailing Address Fax Number:
408-379-0361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 S. WINCHESTER BLVD. E155
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95128-3903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-910-9374
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2013

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:  SP6638 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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