Provider Demographics
NPI:1669604203
Name:CRUMB, SALLY MARIE (MSED)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:MARIE
Last Name:CRUMB
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14360 COUNTY ROAD 408
Mailing Address - Street 2:
Mailing Address - City:AMAZONIA
Mailing Address - State:MO
Mailing Address - Zip Code:64421-8119
Mailing Address - Country:US
Mailing Address - Phone:816-475-2451
Mailing Address - Fax:
Practice Address - Street 1:14360 COUNTY ROAD 408
Practice Address - Street 2:
Practice Address - City:AMAZONIA
Practice Address - State:MO
Practice Address - Zip Code:64421-8119
Practice Address - Country:US
Practice Address - Phone:816-475-2451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-16
Last Update Date:2009-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency