Provider Demographics
NPI:1578716296
Name:CROWELL, BRENDA ANN (MA, CCC/LSLP)
Entity Type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:ANN
Last Name:CROWELL
Suffix:
Gender:F
Credentials:MA, CCC/LSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13363 GALICIA
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-2722
Mailing Address - Country:US
Mailing Address - Phone:210-387-8226
Mailing Address - Fax:
Practice Address - Street 1:13333 BLANCO RD STE 310
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216
Practice Address - Country:US
Practice Address - Phone:210-479-5875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-25
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105241235Z00000X
NY7545-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist