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General NPI Number Information
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NPI Number | 1801565734
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Entity Type | Individual
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Provider Name | NATHANIEL RAY CROSS MS, CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 2301 S BROADWAY AVE STE B10
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City | TYLER
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State | TX
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Zip | 75701-5409
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Country | US
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Telephone | 903-884-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 487 WICHITA ST
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City | BULLARD
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State | TX
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Zip | 75757-6751
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Country | US
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Telephone | 661-917-0042
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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 | 122194
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License Number State | TX
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