Basic Information
| Provider Information | |||||||||
| NPI: | 1255730305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROSS | ||||||||
| FirstName: | CANDACE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 NE LOOP 820 | ||||||||
| Address2: | BUSINESS TOWER 1, SUITE 200 | ||||||||
| City: | HURST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760537209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177896849 | ||||||||
| FaxNumber: | 8177896849 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 EARL RUDDER FWY S | ||||||||
| Address2: | |||||||||
| City: | COLLEGE STATION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778455010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9793075850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2014 | ||||||||
| LastUpdateDate: | 08/14/2014 | ||||||||
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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 | 109504 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.