Provider Demographics
NPI:1982030169
Name:CROUSE, MARJORIE K (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:K
Last Name:CROUSE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:876 EUCLID AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2584
Mailing Address - Country:US
Mailing Address - Phone:404-522-4061
Mailing Address - Fax:
Practice Address - Street 1:1192 FOSTER ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4329
Practice Address - Country:US
Practice Address - Phone:404-377-7436
Practice Address - Fax:404-377-0884
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1640235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist