Basic Information
| Provider Information | |||||||||
| NPI: | 1053808329 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUMBACHER | ||||||||
| FirstName: | KENDRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6922B MOUNTAIN VIEW CT | ||||||||
| Address2: | |||||||||
| City: | TWENTYNINE PALMS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702949389 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14148 FRANCISQUITO AVE | ||||||||
| Address2: | |||||||||
| City: | BALDWIN PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917066120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263882700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2018 | ||||||||
| LastUpdateDate: | 04/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | LL60748995 | WA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 25128 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.