Desiree Crockford
Individual provider Active NPI Speech-Language Pathologist · Mandan, ND
NPI 1003434879 · NPPES record last updated Jul 8, 2020
Key facts
- NPI
- 1003434879
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 1744 (ND)
- Practice address
- 901 Division St NW
Mandan, ND 58554-1641 - Phone
- (701) 751-6500
- NPI assigned
- Jul 8, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1744 | ND | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 1744 | ND | Yes |
Addresses
Primary practice location
901 Division St NW
Mandan, ND 58554-1641
Mailing address
901 Division St NW
Mandan, ND 58554-1641
NPI Registry JSON
{
"created_epoch": "1594166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594166400000",
"number": "1003434879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 DIVISION ST NW",
"city": "MANDAN",
"state": "ND",
"postal_code": "585541641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 DIVISION ST NW",
"city": "MANDAN",
"state": "ND",
"postal_code": "585541641",
"telephone_number": "701-751-6500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROCKFORD",
"first_name": "DESIREE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-08",
"last_updated": "2020-07-08",
"certification_date": "2020-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ND",
"license": "1744",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mandan, ND
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All providers in Mandan, ND · Speech-Language Pathologist in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.