Provider Demographics
NPI:1578536595
Name:CRONIN, CLARE (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:CRONIN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:CLARE
Other - Middle Name:
Other - Last Name:DOLTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:4550 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1017
Mailing Address - Country:US
Mailing Address - Phone:239-931-5700
Mailing Address - Fax:239-931-5738
Practice Address - Street 1:4550 COLONIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1017
Practice Address - Country:US
Practice Address - Phone:239-931-5700
Practice Address - Fax:239-931-5738
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000969231H00000X
FLAY 1451231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600550100Medicaid
FL600550100Medicaid