Provider Demographics
NPI:1841793460
Name:CROTHERS, AMBER N (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:N
Last Name:CROTHERS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 COTTONTAIL LN
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-1612
Mailing Address - Country:US
Mailing Address - Phone:314-780-9003
Mailing Address - Fax:
Practice Address - Street 1:126 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ARTHUR
Practice Address - State:IL
Practice Address - Zip Code:61911-1318
Practice Address - Country:US
Practice Address - Phone:314-780-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist