Provider Demographics
NPI:1790188522
Name:CRAWFORD, AMANDA GAYLE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAYLE
Last Name:CRAWFORD
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-8648
Mailing Address - Country:US
Mailing Address - Phone:850-556-9897
Mailing Address - Fax:
Practice Address - Street 1:1738 THOMASVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5754
Practice Address - Country:US
Practice Address - Phone:850-909-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6875235Z00000X
FLSA14284235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist