Provider Demographics
NPI:1093469959
Name:CROWNOVER, AVERY
Entity Type:Individual
Prefix:MRS
First Name:AVERY
Middle Name:
Last Name:CROWNOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AVERY
Other - Middle Name:
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2460 N INTERSTATE 35 E ROAD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165
Mailing Address - Country:US
Mailing Address - Phone:972-938-3311
Mailing Address - Fax:
Practice Address - Street 1:2460 N I 35 STE 260
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5278
Practice Address - Country:US
Practice Address - Phone:972-938-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist