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NPI Code Detail

MEDICARE: MS. ERIN TRACI CROTTY MS, CCC-SLP

MEDICARE: MS. ERIN TRACI CROTTY MS, CCC-SLP
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
1235Z00000XSpeech-Language PathologistSLP #0815WV

General Provider Information

NPI Number : 1750415089
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ERIN TRACI CROTTY MS, CCC-SLP
Provider Business Mailing Address
First Line : 201 TRAPPERS PL
Second Line :
City : CHARLESTON
State : WV
Zip : 25314-2420
Country : US
Telephone Number : 304-389-4576
Fax Number : 304-347-8526
Provider Business Practice Location Address
First Line : 1000 ASSOCIATION DR
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-1270
Country : US
Telephone Number : 304-347-4372
Fax Number : 304-347-8526
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/08/2007

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