Provider Demographics
NPI:1447804240
Name:CRUM, NATALIE RACHELLE (SLP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:RACHELLE
Last Name:CRUM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80288 GREEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-0837
Mailing Address - Country:US
Mailing Address - Phone:916-696-4459
Mailing Address - Fax:
Practice Address - Street 1:41505 CARLOTTA DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-3279
Practice Address - Country:US
Practice Address - Phone:760-600-5904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13634235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist