Provider Demographics
NPI:1790156958
Name:CRUMBLEY, CHRISTIAN (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:CRUMBLEY
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 ASHLEY ST W
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2308
Mailing Address - Country:US
Mailing Address - Phone:912-331-0846
Mailing Address - Fax:
Practice Address - Street 1:510 ASHLEY ST W
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2308
Practice Address - Country:US
Practice Address - Phone:912-331-0846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007514235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist