Provider Demographics
NPI:1598806853
Name:CROWDER-WILE, MARILYN THERESA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:THERESA
Last Name:CROWDER-WILE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:MARILYN
Other - Middle Name:THERESA
Other - Last Name:CROWDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CFY-SLP
Mailing Address - Street 1:4104 7TH PL NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8454
Mailing Address - Country:US
Mailing Address - Phone:507-281-3001
Mailing Address - Fax:
Practice Address - Street 1:2746 SUPERIOR DR NW
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8343
Practice Address - Country:US
Practice Address - Phone:507-288-0064
Practice Address - Fax:507-288-3993
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist