Provider Demographics
NPI:1053682260
Name:CRIMMINS, ALICIA JOAN (MAM CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ALICIA JOAN
Middle Name:
Last Name:CRIMMINS
Suffix:
Gender:F
Credentials:MAM CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 17TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-4130
Mailing Address - Country:US
Mailing Address - Phone:631-324-2571
Mailing Address - Fax:
Practice Address - Street 1:110 STEPHENS HANDS PATH
Practice Address - Street 2:CDCD
Practice Address - City:WAINSCOTT
Practice Address - State:NY
Practice Address - Zip Code:11975
Practice Address - Country:US
Practice Address - Phone:631-324-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019813-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist