Provider Demographics
NPI:1144355488
Name:CRAWFORD, WANDA KAY (MS CCCA)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:KAY
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MS CCCA
Other - Prefix:MRS
Other - First Name:WANDA
Other - Middle Name:KAY
Other - Last Name:KLEVGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCCA
Mailing Address - Street 1:411 STAGELINE RD # 290
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7848
Mailing Address - Country:US
Mailing Address - Phone:715-531-6710
Mailing Address - Fax:651-888-7820
Practice Address - Street 1:1727 BREVARD RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3259
Practice Address - Country:US
Practice Address - Phone:828-696-8272
Practice Address - Fax:828-696-8790
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI307156231H00000X
MN7961231H00000X
NC14535231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1144355488Medicaid
WI41148500Medicaid