Provider Demographics
NPI:1205207503
Name:CRAWFORD, ADRIENNE THERESE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:THERESE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9466 EMMET ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-4564
Mailing Address - Country:US
Mailing Address - Phone:402-660-6217
Mailing Address - Fax:
Practice Address - Street 1:9466 EMMET ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4564
Practice Address - Country:US
Practice Address - Phone:402-660-6217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1640235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE14091942OtherASHA
NE1640OtherSPEECH-LANGUAGE PATHOLOGIST
NE235200000XOtherSPEECH-LANGUAGE PATHOLOGIST