Provider Demographics
NPI:1528665510
Name:CRAWFORD, CLARICE F (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CLARICE
Middle Name:F
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 1:908 DIVISION ST APT 304
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5770
Mailing Address - Country:US
Mailing Address - Phone:305-934-2297
Mailing Address - Fax:
Practice Address - Street 1:1501 12TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-4909
Practice Address - Country:US
Practice Address - Phone:615-933-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-03
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9828235Z00000X
TN7872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108449900Medicaid