MEDICARE: SHARLA CROFFORD 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	SPP7971	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SPP7971	OTHER	AR	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1932320280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARLA CROFFORD SLP

Provider Business Mailing Address
First Line	:	7096 HWY 124
Second Line	:
City	:	SPRINGFIELD
State	:	AR
Zip	:	72157
Country	:	US
Telephone Number	:	479-495-6326
Fax Number	:	479-495-3336

Provider Business Practice Location Address
First Line	:	714 N DETROIT ST
Second Line	:
City	:	DANVILLE
State	:	AR
Zip	:	72833
Country	:	US
Telephone Number	:	479-495-6326
Fax Number	:	479-495-3336

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	12/23/2009

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Directions to “ SHARLA CROFFORD SLP” Practice Location

Language	Start Address	Practice Location

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