Provider Demographics
NPI:1346669736
Name:CROSBY, MICHAEL (M ED CCC/SLP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:CROSBY
Suffix:
Gender:M
Credentials:M ED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 KNOLLWOOD WAY NW
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-2510
Mailing Address - Country:US
Mailing Address - Phone:404-218-5092
Mailing Address - Fax:
Practice Address - Street 1:19 KNOLLWOOD WAY NW
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-2510
Practice Address - Country:US
Practice Address - Phone:404-218-5092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist