Provider Demographics
NPI:1710915152
Name:CRAIG, AVA BRODIE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AVA
Middle Name:BRODIE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:AVA
Other - Middle Name:B
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:20634 MOUNTAINSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8862
Mailing Address - Country:US
Mailing Address - Phone:907-622-8217
Mailing Address - Fax:907-580-5520
Practice Address - Street 1:5955 ZEAMER AVE
Practice Address - Street 2:3MSGS/SGCUN
Practice Address - City:ELMENDORF AFB
Practice Address - State:AK
Practice Address - Zip Code:99506-3702
Practice Address - Country:US
Practice Address - Phone:907-580-5804
Practice Address - Fax:907-580-5520
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist