Provider Demographics
NPI:1770395154
Name:CROMER, CASSIDY BROOKE (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:BROOKE
Last Name:CROMER
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 MORTON ST APT 409
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5408
Mailing Address - Country:US
Mailing Address - Phone:540-392-2659
Mailing Address - Fax:
Practice Address - Street 1:4410 MONROE RD STE F
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7720
Practice Address - Country:US
Practice Address - Phone:828-845-4079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist