MEDICARE: WENDY RENEE CRAWFORD

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	222Q00000X	Developmental Therapist
2	235Z00000X	Speech-Language Pathologist	SA5831	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780627620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY RENEE CRAWFORD

Provider Business Mailing Address
First Line	:	4829 INNISBROOK CT S
Second Line	:
City	:	ELKTON
State	:	FL
Zip	:	32033-2067
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 INNISBROOK CT S
Second Line	:
City	:	ELKTON
State	:	FL
Zip	:	32033-2067
Country	:	US
Telephone Number	:	904-374-1414
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/30/2013

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Directions to “ WENDY RENEE CRAWFORD ” Practice Location

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