Provider Demographics
NPI:1275067571
Name:CRAWFORD THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:CRAWFORD THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:318-286-5612
Mailing Address - Street 1:376 HIGHWAY 517
Mailing Address - Street 2:
Mailing Address - City:GIBSLAND
Mailing Address - State:LA
Mailing Address - Zip Code:71028-4652
Mailing Address - Country:US
Mailing Address - Phone:318-286-5612
Mailing Address - Fax:318-300-1119
Practice Address - Street 1:206 E REYNOLDS DR
Practice Address - Street 2:SUITE G1
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2809
Practice Address - Country:US
Practice Address - Phone:318-286-5612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2388967Medicaid