Provider Demographics
NPI:1386406288
Name:CRESPO, CARRIE ANNA (MA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANNA
Last Name:CRESPO
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 1:2005 ALPINE ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-2519
Mailing Address - Country:US
Mailing Address - Phone:120-891-9899
Mailing Address - Fax:
Practice Address - Street 1:2005 ALPINE ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-2519
Practice Address - Country:US
Practice Address - Phone:720-652-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO350797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist