Provider Demographics
NPI:1942929807
Name:CROSS, MISTY G (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:G
Last Name:CROSS
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 1:6123 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6429
Mailing Address - Country:US
Mailing Address - Phone:509-230-8033
Mailing Address - Fax:
Practice Address - Street 1:6363 N SMITH ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-7616
Practice Address - Country:US
Practice Address - Phone:509-354-2098
Practice Address - Fax:509-354-2121
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASLP.LL.61351354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist