Provider Demographics
NPI:1629030382
Name:CRABTREE, AMY L (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:CRABTREE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2523 14 3/4 AVE
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868
Mailing Address - Country:US
Mailing Address - Phone:715-859-6670
Mailing Address - Fax:715-859-6669
Practice Address - Street 1:2523 14 3/4 AVE
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868
Practice Address - Country:US
Practice Address - Phone:715-859-6670
Practice Address - Fax:715-859-6669
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2548154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42802100Medicaid