Provider Demographics
NPI:1841786365
Name:CRUM, WHITNEY PAIGE (MS, CFY-SLP)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:PAIGE
Last Name:CRUM
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 WOODLAND TRCE W
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-7501
Mailing Address - Country:US
Mailing Address - Phone:901-283-8753
Mailing Address - Fax:
Practice Address - Street 1:LASKIN THERAPY GROUP PA
Practice Address - Street 2:207 W JACKSON ST
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157
Practice Address - Country:US
Practice Address - Phone:601-427-5703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200529321Medicaid