Provider Demographics
NPI:1952674350
Name:CROTTS, MARLA SAMANTHA (MED, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:SAMANTHA
Last Name:CROTTS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MRS
Other - First Name:MARLA
Other - Middle Name:SAMANTHA
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:2042 10TH STREET LN NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-1763
Mailing Address - Country:US
Mailing Address - Phone:828-446-2435
Mailing Address - Fax:
Practice Address - Street 1:2042 10TH STREET LN NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-1763
Practice Address - Country:US
Practice Address - Phone:828-446-2435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist