Individual
PHAEDRA CRISMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
44 BROAD STREET RD, ROUTE 250, MANAKIN SABOT, VA 23103-2213
(804) 784-7090
(804) 784-7092
Mailing address
655 NORTHERN BLVD, SOUTH ABINGTON TOWNSHIP, PA 18411-8740
(570) 842-9323
(570) 842-9362
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202005546
VA
Other
Enumeration date
10/31/2016
Last updated
10/31/2016
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