1902977010 NPI number — MRS. JANE CRUMLEY M.S.CCC-SLP

Table of content: MRS. JANE CRUMLEY M.S.CCC-SLP (NPI 1902977010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902977010 NPI number — MRS. JANE CRUMLEY M.S.CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUMLEY
Provider First Name:
JANE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.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:
1902977010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 483
Provider Second Line Business Mailing Address:
SUITE H
Provider Business Mailing Address City Name:
PORTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77365-0483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-440-8658
Provider Business Mailing Address Fax Number:
956-440-1412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1906 E TYLER AVE
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-7106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-440-8658
Provider Business Practice Location Address Fax Number:
956-440-1412
Provider Enumeration Date:
11/11/2006

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:  15050 , 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: 136482100 . This is a "VALLEY HEALTHPLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 003552902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 87536T . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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