Provider Demographics
NPI:1215018809
Name:MC CRUMB, PATRICIA LYNN (MS)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LYNN
Last Name:MC CRUMB
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S MARY AVE
Mailing Address - Street 2:39
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-5810
Mailing Address - Country:US
Mailing Address - Phone:408-242-2831
Mailing Address - Fax:
Practice Address - Street 1:696 E. SANTA CLARA STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112
Practice Address - Country:US
Practice Address - Phone:408-288-6604
Practice Address - Fax:408-288-8524
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2383231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU 0023830Medicaid