Provider Demographics
NPI:1477609782
Name:CROFT, ALECIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALECIA
Middle Name:
Last Name:CROFT
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 1:786 SE PEACOCK TER
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-8241
Mailing Address - Country:US
Mailing Address - Phone:386-623-0276
Mailing Address - Fax:
Practice Address - Street 1:786 SE PEACOCK TER
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-8241
Practice Address - Country:US
Practice Address - Phone:386-623-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA8701OtherDEPARTMENT OF HEALTH
FL12085659OtherASHA