1841786365 NPI number — WHITNEY PAIGE CRUM M.S., CFY-SLP

Table of content: MISS JESSICA NICHOLE GRUVER BA (NPI 1760616577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841786365 NPI number — WHITNEY PAIGE CRUM M.S., CFY-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUM
Provider First Name:
WHITNEY
Provider Middle Name:
PAIGE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., CFY-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:
1841786365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 WOODLAND TRCE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHAVEN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38672-7501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-283-8753
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LASKIN THERAPY GROUP PA
Provider Second Line Business Practice Location Address:
207 W JACKSON ST
Provider Business Practice Location Address City Name:
RIDGELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-427-5703
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2018

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200529321 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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