Provider Demographics
NPI:1720271075
Name:CROSBY, CAROLINE (MS,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:CROSBY
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 BISHOPS LODGE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-0003
Mailing Address - Country:US
Mailing Address - Phone:505-989-8926
Mailing Address - Fax:
Practice Address - Street 1:1426 BISHOPS LODGE RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-0003
Practice Address - Country:US
Practice Address - Phone:505-989-8926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMJ4323Medicaid