Provider Demographics
NPI:1609058148
Name:CRAWFORD, GWENDOLYN M (M ED SLP)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:M
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:M ED SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11817 PARKMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4630
Mailing Address - Country:US
Mailing Address - Phone:225-292-4898
Mailing Address - Fax:
Practice Address - Street 1:11817 PARKMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4630
Practice Address - Country:US
Practice Address - Phone:225-292-4898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3755235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist