Provider Demographics
NPI:1063011914
Name:CROOM, NATALIA N
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:N
Last Name:CROOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 GATEWAY DR APT 3B
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-5040
Mailing Address - Country:US
Mailing Address - Phone:757-610-6943
Mailing Address - Fax:
Practice Address - Street 1:801 CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-3822
Practice Address - Country:US
Practice Address - Phone:757-393-8751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist