Provider Demographics
NPI:1932320280
Name:CROFFORD, SHARLA (SLP)
Entity Type:Individual
Prefix:
First Name:SHARLA
Middle Name:
Last Name:CROFFORD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SHARLA
Other - Middle Name:
Other - Last Name:CROFFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:7096 HWY 124
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72157
Mailing Address - Country:US
Mailing Address - Phone:479-495-6326
Mailing Address - Fax:479-495-3336
Practice Address - Street 1:714 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:AR
Practice Address - Zip Code:72833
Practice Address - Country:US
Practice Address - Phone:479-495-6326
Practice Address - Fax:479-495-3336
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSPP7971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARSPP7971OtherSTATE LICENSE NUMBER