Provider Demographics
NPI:1215239306
Name:CRAWFORD, KRISTEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
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 1:5719 NUTMEG AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-2534
Mailing Address - Country:US
Mailing Address - Phone:610-202-9078
Mailing Address - Fax:
Practice Address - Street 1:6977 PROFESSIONAL PKWY E
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8411
Practice Address - Country:US
Practice Address - Phone:941-758-3140
Practice Address - Fax:941-870-4891
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004823L235Z00000X
FLSA12671235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019211700Medicaid