=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033022777
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELLI CRANDALL CF-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2026
-----------------------------------------------------
Last Update Date | 09/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 MEMORIAL DR
-----------------------------------------------------
City | FENNVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49408-9370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-722-3900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1499 64TH ST
-----------------------------------------------------
City | FENNVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49408-9506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 7152001529
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------