Provider Demographics
NPI:1386019644
Name:CROWSON, BROOKE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:CROWSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 LABURNUM AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6041
Mailing Address - Country:US
Mailing Address - Phone:704-968-7461
Mailing Address - Fax:
Practice Address - Street 1:2101 LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6041
Practice Address - Country:US
Practice Address - Phone:704-968-7461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist