Provider Demographics
NPI:1245668409
Name:CROW, GREGORY (MS, SLP INTERN)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:CROW
Suffix:
Gender:M
Credentials:MS, SLP INTERN
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:ERIC
Other - Last Name:CROW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:440 HIGHWAY 59 LOOP S STE 104
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-9011
Mailing Address - Country:US
Mailing Address - Phone:936-328-8148
Mailing Address - Fax:936-327-2491
Practice Address - Street 1:440 HIGHWAY 59 LOOP S STE 104
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9011
Practice Address - Country:US
Practice Address - Phone:936-328-8148
Practice Address - Fax:936-327-2491
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist