Provider Demographics
NPI:1720238041
Name:CRABTREE, DEDRA (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEDRA
Middle Name:
Last Name:CRABTREE
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:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:THIDA
Mailing Address - State:AR
Mailing Address - Zip Code:72165-0004
Mailing Address - Country:US
Mailing Address - Phone:870-503-1556
Mailing Address - Fax:
Practice Address - Street 1:415 ALLEN ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-6958
Practice Address - Country:US
Practice Address - Phone:870-612-1717
Practice Address - Fax:870-612-1719
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist