MEDICARE: CINDY DAWN CROUCH

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	2355S0801X	Speech-Language Assistant	SLPA8413	AZ

General Provider Information

NPI Number	:	1114308699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDY DAWN CROUCH

Provider Business Mailing Address
First Line	:	4627 W STONEMAN DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-1444
Country	:	US
Telephone Number	:	623-256-3010
Fax Number	:

Provider Business Practice Location Address
First Line	:	4627 W STONEMAN DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-1444
Country	:	US
Telephone Number	:	623-256-3010
Fax Number	:

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

Provider Enumeration Date	:	06/10/2015
Last Update Date	:	06/10/2015

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Directions to “ CINDY DAWN CROUCH ” Practice Location

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