Provider Demographics
NPI:1205195104
Name:CRUTCHFIELD SPEECH & LANGUAGE
Entity Type:Organization
Organization Name:CRUTCHFIELD SPEECH & LANGUAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUTCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-337-0153
Mailing Address - Street 1:4305 FOUR FARMS RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 COLLEGE RD
Practice Address - Street 2:SUITE 13
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-5194
Practice Address - Country:US
Practice Address - Phone:336-337-0153
Practice Address - Fax:336-297-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty