Provider Demographics
NPI:1255676813
Name:CROUCH, PAMELA KAY (MA,CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KAY
Last Name:CROUCH
Suffix:
Gender:F
Credentials:MA,CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18557 KINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-2710
Mailing Address - Country:US
Mailing Address - Phone:813-960-1775
Mailing Address - Fax:813-960-1775
Practice Address - Street 1:1980 SUNSET POINT RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1132
Practice Address - Country:US
Practice Address - Phone:727-443-1588
Practice Address - Fax:727-442-5916
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2959235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist