Provider Demographics
NPI:1366313462
Name:CROSBY, MIKHAIL CHANG (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:CHANG
Last Name:CROSBY
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34693 SPOONBILL CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2851
Mailing Address - Country:US
Mailing Address - Phone:510-579-4821
Mailing Address - Fax:
Practice Address - Street 1:34693 SPOONBILL CMN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-2851
Practice Address - Country:US
Practice Address - Phone:510-579-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-13
Last Update Date:2025-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist