MEDICARE: KIMBERLY CROSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41YS00734900	NJ

General Provider Information

NPI Number	:	1164966776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY CROSON

Provider Business Mailing Address
First Line	:	28 DEBORAH LN
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-3504
Country	:	US
Telephone Number	:	732-513-1359
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 PLAZA DR STE 12
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08757-3765
Country	:	US
Telephone Number	:	732-886-6996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2016
Last Update Date	:	10/27/2021

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Directions to “ KIMBERLY CROSON ” Practice Location

Language	Start Address	Practice Location

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