Provider Demographics
NPI:1376042184
Name:CRAWFORD, OLIVIA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CORPORATE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4638
Mailing Address - Country:US
Mailing Address - Phone:706-633-4202
Mailing Address - Fax:865-769-0801
Practice Address - Street 1:310 CORPORATE DR STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4638
Practice Address - Country:US
Practice Address - Phone:865-693-5622
Practice Address - Fax:865-769-0801
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000007014235Z00000X
GASLP009658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist