Provider Demographics
NPI:1497236459
Name:CRAWFORD, GEORGIA (SLP)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:ROMBAKIS
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:1306 DEVON GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3212
Mailing Address - Country:US
Mailing Address - Phone:281-224-2455
Mailing Address - Fax:
Practice Address - Street 1:3625 GREEN CREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-4056
Practice Address - Country:US
Practice Address - Phone:281-558-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11462OtherPROFESSIONAL LICENSE