Provider Demographics
NPI:1942700901
Name:CROYLE-NIELSEN HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:CROYLE-NIELSEN HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESPER
Authorized Official - Middle Name:P
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-266-3196
Mailing Address - Street 1:336 BLOOMFIELD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3271
Mailing Address - Country:US
Mailing Address - Phone:814-266-3196
Mailing Address - Fax:
Practice Address - Street 1:336 BLOOMFIELD ST STE 203
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3271
Practice Address - Country:US
Practice Address - Phone:814-266-3196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty