Provider Demographics
NPI:1407218506
Name:CRAFT, DENNIS ANTHONY (SLP MA CCC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:ANTHONY
Last Name:CRAFT
Suffix:
Gender:M
Credentials:SLP MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W 6TH ST STE 11
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 W 6TH ST STE 11
Practice Address - Street 2:SUITE 11
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1800
Practice Address - Country:US
Practice Address - Phone:916-730-6570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 22781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA235Z00000XOtherSPEECH LANGUAGE CCC