Provider Demographics
NPI:1679652176
Name:CREW SPEECH & LANGUAGE GROUP, INC
Entity Type:Organization
Organization Name:CREW SPEECH & LANGUAGE GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CREW
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:912-576-9603
Mailing Address - Street 1:2015 OSBORNE RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-9164
Mailing Address - Country:US
Mailing Address - Phone:912-576-9603
Mailing Address - Fax:912-576-9865
Practice Address - Street 1:2015 OSBORNE RD STE A
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-9164
Practice Address - Country:US
Practice Address - Phone:912-576-9603
Practice Address - Fax:912-576-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005785235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA896037962BMedicaid