Provider Demographics
NPI:1902207749
Name:CRAWFORD, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:CRAWFORD
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 1:14391 METROPOLIS AVE
Mailing Address - Street 2:101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4421
Mailing Address - Country:US
Mailing Address - Phone:239-561-2778
Mailing Address - Fax:239-561-8107
Practice Address - Street 1:14391 METROPOLIS AVE
Practice Address - Street 2:101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4421
Practice Address - Country:US
Practice Address - Phone:239-561-2778
Practice Address - Fax:239-561-8107
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 13442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist