Provider Demographics
NPI:1619134558
Name:CRABTREE, MIRANDA RENEE
Entity Type:Individual
Prefix:MISS
First Name:MIRANDA
Middle Name:RENEE
Last Name:CRABTREE
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 1:138 DOGWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-7232
Mailing Address - Country:US
Mailing Address - Phone:479-632-1438
Mailing Address - Fax:
Practice Address - Street 1:916 HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-7382
Practice Address - Country:US
Practice Address - Phone:479-632-2168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist