Provider Demographics
NPI:1417509381
Name:CROWLEY, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CROWLEY
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 1:290 BRANDYWINE BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1560
Mailing Address - Country:US
Mailing Address - Phone:770-460-0615
Mailing Address - Fax:770-460-0189
Practice Address - Street 1:290 BRANDYWINE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1560
Practice Address - Country:US
Practice Address - Phone:770-460-0615
Practice Address - Fax:770-460-0189
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SLP008745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist