Provider Demographics
NPI:1831208990
Name:CRUMPLER, MELISSA (SLP/CCC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CRUMPLER
Suffix:
Gender:F
Credentials:SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 SW 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2202
Mailing Address - Country:US
Mailing Address - Phone:305-541-3400
Mailing Address - Fax:305-541-3344
Practice Address - Street 1:1441 SW 1ST STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2202
Practice Address - Country:US
Practice Address - Phone:305-541-3400
Practice Address - Fax:305-541-3344
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12081939OtherASHA
FL890530400Medicaid
FLS3082OtherBCBS OF FLORIDA