Provider Demographics
NPI:1255534608
Name:CRAWFORD, KRISTIE S (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:S
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MA, 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:P.O. BOX 1306
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-1306
Mailing Address - Country:US
Mailing Address - Phone:318-255-9601
Mailing Address - Fax:318-255-7591
Practice Address - Street 1:1817 NORTHPOINTE LANE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3879
Practice Address - Country:US
Practice Address - Phone:318-255-9601
Practice Address - Fax:318-255-7591
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1007994Medicaid