Provider Demographics
NPI:1932465986
Name:KROL, MARTIE (MS, CCC, SLP, BCBA)
Entity Type:Individual
Prefix:
First Name:MARTIE
Middle Name:
Last Name:KROL
Suffix:
Gender:F
Credentials:MS, CCC, SLP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 DOROTHY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-1742
Mailing Address - Country:US
Mailing Address - Phone:845-548-4043
Mailing Address - Fax:
Practice Address - Street 1:721 DOROTHY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-1742
Practice Address - Country:US
Practice Address - Phone:845-548-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-14-16142103K00000X
TX3351103K00000X
NY021474-1235Z00000X
TX114204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst