Provider Demographics
NPI:1992841092
Name:CROWE, BRADLEY THOMAS (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:THOMAS
Last Name:CROWE
Suffix:
Gender:M
Credentials: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:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY
Mailing Address - State:MS
Mailing Address - Zip Code:38677
Mailing Address - Country:US
Mailing Address - Phone:662-915-7271
Mailing Address - Fax:662-915-7263
Practice Address - Street 1:2301 SOUTH LAMAR BLVD
Practice Address - Street 2:SUITE 1200
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-915-7271
Practice Address - Fax:662-915-7263
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2239235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist