Provider Demographics
NPI:1053747329
Name:CROSHAW, DIANA ANDERSON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ANDERSON
Last Name:CROSHAW
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 1:13214 W UTAH CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4228
Mailing Address - Country:US
Mailing Address - Phone:801-404-3650
Mailing Address - Fax:
Practice Address - Street 1:5420 S QUEBEC ST STE 103
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1902
Practice Address - Country:US
Practice Address - Phone:303-221-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0001555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist