Provider Demographics
NPI:1053755686
Name:CRAWFORD, PATRICAI ANN
Entity type:Individual
Prefix:MRS
First Name:PATRICAI
Middle Name:ANN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15561 N 1700TH ST
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:TEUTOPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62467-3449
Mailing Address - Country:US
Mailing Address - Phone:217-857-6644
Mailing Address - Fax:
Practice Address - Street 1:15561 N 1700TH ST
Practice Address - Street 2:
Practice Address - City:TEUTOPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62467-3449
Practice Address - Country:US
Practice Address - Phone:217-857-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146001157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist