Provider Demographics
NPI:1992087902
Name:CRISAFULLI, TAMI S (MS CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:TAMI
Middle Name:S
Last Name:CRISAFULLI
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 1:368A MOE RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5115
Mailing Address - Country:US
Mailing Address - Phone:518-371-9187
Mailing Address - Fax:
Practice Address - Street 1:1190 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1014
Practice Address - Country:US
Practice Address - Phone:518-836-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006994-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist