Provider Demographics
NPI:1871018895
Name:CROCKER, ALANA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:
Last Name:CROCKER
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 1:14 GREENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PUTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05346-8965
Mailing Address - Country:US
Mailing Address - Phone:802-387-4545
Mailing Address - Fax:
Practice Address - Street 1:14 GREENWOOD LN
Practice Address - Street 2:
Practice Address - City:PUTNEY
Practice Address - State:VT
Practice Address - Zip Code:05346-8965
Practice Address - Country:US
Practice Address - Phone:802-387-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0132265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist