Provider Demographics
NPI:1861548091
Name:CRANE, DENISE LYNN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:LYNN
Last Name:CRANE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC RT 1 BOX 136
Mailing Address - Street 2:
Mailing Address - City:GRANDIN
Mailing Address - State:MO
Mailing Address - Zip Code:63943
Mailing Address - Country:US
Mailing Address - Phone:573-322-8020
Mailing Address - Fax:
Practice Address - Street 1:24 S HERREN AVE
Practice Address - Street 2:
Practice Address - City:ELLSINORE
Practice Address - State:MO
Practice Address - Zip Code:63937-8208
Practice Address - Country:US
Practice Address - Phone:573-322-8319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006028755235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist