Provider Demographics
NPI:1821557042
Name:CROWN PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:CROWN PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUDERBUAGH BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:832-689-6248
Mailing Address - Street 1:6 ENGLISH HEATHER PL
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1076
Mailing Address - Country:US
Mailing Address - Phone:832-689-6248
Mailing Address - Fax:
Practice Address - Street 1:6 ENGLISH HEATHER PL
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-1076
Practice Address - Country:US
Practice Address - Phone:832-689-6248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty