Provider Demographics
NPI:1154499762
Name:CROSS, BRENDA FIELDS (AUD, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:FIELDS
Last Name:CROSS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:DIAN
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:BOX 60757
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79016-0001
Mailing Address - Country:US
Mailing Address - Phone:806-651-5101
Mailing Address - Fax:806-651-5105
Practice Address - Street 1:720 S TYLER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-2313
Practice Address - Country:US
Practice Address - Phone:806-651-5101
Practice Address - Fax:806-651-5105
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60533231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist