Provider Demographics
NPI:1790948644
Name:CROLL, NANETTE B (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:NANETTE
Middle Name:B
Last Name:CROLL
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 PEDERSEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-7269
Mailing Address - Country:US
Mailing Address - Phone:570-296-2505
Mailing Address - Fax:570-296-2505
Practice Address - Street 1:182 PEDERSEN RIDGE RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-7269
Practice Address - Country:US
Practice Address - Phone:570-296-2505
Practice Address - Fax:570-296-2505
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004614L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist