Provider Demographics
NPI:1326473364
Name:KROM, EILEEN ANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:EILEEN
Middle Name:ANNE
Last Name:KROM
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:GRAHAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12740-5407
Mailing Address - Country:US
Mailing Address - Phone:845-807-6842
Mailing Address - Fax:
Practice Address - Street 1:33 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12748-5815
Practice Address - Country:US
Practice Address - Phone:845-482-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist