Provider Demographics
NPI:1174953939
Name:CRAANEN, PATRICK M (EDD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:M
Last Name:CRAANEN
Suffix:
Gender:M
Credentials:EDD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5594 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-7190
Mailing Address - Country:US
Mailing Address - Phone:321-693-0391
Mailing Address - Fax:
Practice Address - Street 1:5594 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-7190
Practice Address - Country:US
Practice Address - Phone:321-693-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist