Provider Demographics
NPI:1316076649
Name:CRUTCHFIELD, TAMARA HOLIMAN (MS,CC,C,-SLP)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:HOLIMAN
Last Name:CRUTCHFIELD
Suffix:
Gender:F
Credentials:MS,CC,C,-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 HIGHWAY 291 S
Mailing Address - Street 2:
Mailing Address - City:PRATTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72129-9151
Mailing Address - Country:US
Mailing Address - Phone:870-699-4423
Mailing Address - Fax:
Practice Address - Street 1:1807 W MOLINE ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-2645
Practice Address - Country:US
Practice Address - Phone:501-467-3166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist