Provider Demographics
NPI:1407054661
Name:CRAWFORD HOLLAND, KIM MARIE
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MARIE
Last Name:CRAWFORD HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 S CYPRESS RD APT 212
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7046
Mailing Address - Country:US
Mailing Address - Phone:954-782-3579
Mailing Address - Fax:
Practice Address - Street 1:138 S CYPRESS RD APT 212
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7046
Practice Address - Country:US
Practice Address - Phone:954-782-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8326235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist