Provider Demographics
NPI:1952654329
Name:CROYLE, EDANA COOLE
Entity Type:Individual
Prefix:
First Name:EDANA
Middle Name:COOLE
Last Name:CROYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SW H K DODGEN LOOP
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7062
Mailing Address - Country:US
Mailing Address - Phone:254-774-9991
Mailing Address - Fax:254-774-9980
Practice Address - Street 1:2010 SW H K DODGEN LOOP
Practice Address - Street 2:SUITE 201
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7062
Practice Address - Country:US
Practice Address - Phone:254-774-9991
Practice Address - Fax:254-774-9980
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX207164901Medicaid
TX149984001Medicaid
TX456606Medicare PIN