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General NPI Number Information
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NPI Number | 1245145176
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Entity Type | Individual
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Provider Name | KELLY DIANE CRONK
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Gender | Female
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Dates
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Enumeration Date | 08/17/2026
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | 210 TOWN CENTER DR
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City | TROY
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State | MI
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Zip | 48084-1774
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Country | US
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Telephone | 248-643-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 37565 LAKEVILLE ST
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City | HARRISON TOWNSHIP
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State | MI
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Zip | 48045-2880
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Country | US
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Telephone | 248-882-4998
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101003466
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License Number State | MI
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