Provider Demographics
NPI:1942780721
Name:PARENT, CRAIG (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:PARENT
Suffix:
Gender:M
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-3719
Mailing Address - Country:US
Mailing Address - Phone:318-773-1392
Mailing Address - Fax:
Practice Address - Street 1:215 FM 161 S
Practice Address - Street 2:
Practice Address - City:HUGHES SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75656-6993
Practice Address - Country:US
Practice Address - Phone:903-639-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist