Basic Information
| Provider Information | |||||||||
| NPI: | 1255676813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROUCH | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA,CCC.SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18557 KINGBIRD DR | ||||||||
| Address2: | |||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335582710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139601775 | ||||||||
| FaxNumber: | 8139601775 | ||||||||
| Practice Location | |||||||||
| Address1: | 1980 SUNSET POINT RD | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337651132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274431588 | ||||||||
| FaxNumber: | 7274425916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA2959 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.