Provider Demographics
NPI:1942442363
Name:CRAIG, MISCHA (MEDCCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:MISCHA
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MEDCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FIANNA WAY
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72919-9008
Mailing Address - Country:US
Mailing Address - Phone:125-623-4701
Mailing Address - Fax:
Practice Address - Street 1:1000 FIANNA WAY
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72919-9008
Practice Address - Country:US
Practice Address - Phone:125-623-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist