Provider Demographics
NPI:1245252261
Name:CROSBY-QUINATOA, EUGENIA (MSP)
Entity type:Individual
Prefix:MRS
First Name:EUGENIA
Middle Name:
Last Name:CROSBY-QUINATOA
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 SUMTER ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3323
Mailing Address - Country:US
Mailing Address - Phone:803-777-2671
Mailing Address - Fax:
Practice Address - Street 1:1224 SUMTER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3323
Practice Address - Country:US
Practice Address - Phone:803-777-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1245252261OtherNPI
SCSA1363Medicaid