Basic Information
| Provider Information | |||||||||
| NPI: | 1255520144 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAWFORD | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS.CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14534 N ASTER AVE | ||||||||
| Address2: | |||||||||
| City: | GARDENDALE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797584720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326318162 | ||||||||
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| Practice Location | |||||||||
| Address1: | 808 TOWER DR | ||||||||
| Address2: | STE 7 | ||||||||
| City: | ODESSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797614239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4323358777 | ||||||||
| FaxNumber: | 4323358787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2007 | ||||||||
| LastUpdateDate: | 01/25/2011 | ||||||||
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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 | 24554 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 24554 | 01 | TX | TEXAS LICENSE | OTHER |