Provider Demographics
NPI:1215211289
Name:CRIMMINS, SAMANTHA GRACE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:GRACE
Last Name:CRIMMINS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-8302
Mailing Address - Country:US
Mailing Address - Phone:303-919-9811
Mailing Address - Fax:
Practice Address - Street 1:2602 12TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-8302
Practice Address - Country:US
Practice Address - Phone:303-919-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12105752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist