Provider Demographics
NPI:1063455509
Name:CRAWFORD, LESLIE ANN (MA)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14775 ROUND MOUNTAIN HTS
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-6411
Mailing Address - Country:US
Mailing Address - Phone:805-438-3265
Mailing Address - Fax:805-544-7641
Practice Address - Street 1:1103 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3303
Practice Address - Country:US
Practice Address - Phone:805-544-7640
Practice Address - Fax:805-544-7641
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP8623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist