Provider Demographics
NPI:1134284987
Name:CROW, CAROLINE (SPEECH THERAPIST)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:CROW
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13814 ABINGER CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3735
Mailing Address - Country:US
Mailing Address - Phone:501-944-5968
Mailing Address - Fax:
Practice Address - Street 1:13814 ABINGER CT
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-3735
Practice Address - Country:US
Practice Address - Phone:501-944-5968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP2051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X517OtherBLUE CROSS BLUE SHIELD
AR150368721Medicaid