MEDICARE: MR. BENJAMIN MATTHEW CROMER M.S., 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
1	235Z00000X	Speech-Language Pathologist	105598	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	105598	OTHER	TX	TEXAS BOARD OF SPEECH LANGUAGE PATHOLOGY
2	12130921	OTHER	TX	AMERICAN SPEECH LANGUAGE AND HEARING ASSOCIATION

General Provider Information

NPI Number	:	1538402110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN MATTHEW CROMER M.S., CCC/SLP

Provider Business Mailing Address
First Line	:	1520 SHERWOOD FOREST ST APT 318
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-3826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 SHERWOOD FOREST ST APT 318
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-3826
Country	:	US
Telephone Number	:	713-855-2013
Fax Number	:

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

Provider Enumeration Date	:	04/01/2013
Last Update Date	:	04/01/2013

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Directions to “ MR. BENJAMIN MATTHEW CROMER M.S., CCC/SLP” Practice Location

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