Healthcare Provider Details

I. General information

NPI: 1154254860
Provider Name (Legal Business Name): DANIELLE FAYE CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 23RD AVE S STE 400
FARGO ND
58104-8783
US

IV. Provider business mailing address

4575 23RD AVE S STE 400
FARGO ND
58104-8783
US

V. Phone/Fax

Practice location:
  • Phone: 701-347-1782
  • Fax: 701-404-8274
Mailing address:
  • Phone: 701-347-1782
  • Fax: 701-404-8274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3132
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: