Provider Demographics
NPI:1992901953
Name:CRAWFORD, KIMBERLY JO (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JO
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 1:1276 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2954
Mailing Address - Country:US
Mailing Address - Phone:651-253-0446
Mailing Address - Fax:
Practice Address - Street 1:1661 PARK RIDGE DR
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2841
Practice Address - Country:US
Practice Address - Phone:952-403-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist