Provider Demographics
NPI:1598297236
Name:CROWE, DEBRA (SLP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:CROWE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 BLACK RUSH CIR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8083
Mailing Address - Country:US
Mailing Address - Phone:845-702-2870
Mailing Address - Fax:
Practice Address - Street 1:1143 BLACK RUSH CIR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8083
Practice Address - Country:US
Practice Address - Phone:845-702-2870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5364235Z00000X
FL15072235Z00000X
AZ10481235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist