Provider Demographics
NPI:1780773713
Name:CROWDER, JEAN KATHERINE (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:KATHERINE
Last Name:CROWDER
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 1:7103 SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6831
Mailing Address - Country:US
Mailing Address - Phone:850-434-7755
Mailing Address - Fax:850-469-0858
Practice Address - Street 1:3916 N 10TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2807
Practice Address - Country:US
Practice Address - Phone:850-434-7755
Practice Address - Fax:850-469-0858
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist