MEDICARE: CARRIE CROFFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	7425	NC

General Provider Information

NPI Number	:	1154589281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE CROFFORD

Provider Business Mailing Address
First Line	:	31 S TALBERT BLVD # 255
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-4025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 S TALBERT BLVD # 255
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-4025
Country	:	US
Telephone Number	:	336-475-5234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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Directions to “ CARRIE CROFFORD ” Practice Location

Language	Start Address	Practice Location

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