MEDICARE: ALEXIA MARIAH CRUTCHFIELD MS. ED., CCC-SLP

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	031783-01	NY

General Provider Information

NPI Number	:	1750078341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIA MARIAH CRUTCHFIELD MS. ED., CCC-SLP

Provider Business Mailing Address
First Line	:	151 CHESTNUT ST
Second Line	:
City	:	LOCKPORT
State	:	NY
Zip	:	14094-2947
Country	:	US
Telephone Number	:	716-261-6810
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 BATES RD
Second Line	:
City	:	MEDINA
State	:	NY
Zip	:	14103-9706
Country	:	US
Telephone Number	:	716-261-6810
Fax Number	:

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

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	04/24/2023

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Directions to “ ALEXIA MARIAH CRUTCHFIELD MS. ED., CCC-SLP” Practice Location

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