Provider Demographics
NPI:1013453901
Name:CRAWFORD, ALLY (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLY
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BASS PLANTATION DR
Mailing Address - Street 2:APT 903
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5735
Mailing Address - Country:US
Mailing Address - Phone:912-687-3697
Mailing Address - Fax:
Practice Address - Street 1:105 BASS PLANTATION DR
Practice Address - Street 2:APT 903
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5735
Practice Address - Country:US
Practice Address - Phone:912-687-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008976235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist