Provider Demographics
NPI:1114049715
Name:CRANDALL, LINDA JEAN (BA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 RED JOHN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-1016
Mailing Address - Country:US
Mailing Address - Phone:386-236-1770
Mailing Address - Fax:
Practice Address - Street 1:1150 RED JOHN DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-1016
Practice Address - Country:US
Practice Address - Phone:386-236-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health