Provider Demographics
NPI:1699565523
Name:CRUM, RYAN GRACE (MED, CF-SLP)
Entity type:Individual
Prefix:MS
First Name:RYAN
Middle Name:GRACE
Last Name:CRUM
Suffix:
Gender:F
Credentials:MED, CF-SLP
Other - Prefix:MS
Other - First Name:GRACIE
Other - Middle Name:
Other - Last Name:CRUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, CF-SLP
Mailing Address - Street 1:3003 CARNEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-4900
Mailing Address - Country:US
Mailing Address - Phone:757-802-1696
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 2001
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-2001
Practice Address - Country:US
Practice Address - Phone:434-825-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204001563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist