Provider Demographics
NPI:1538402110
Name:CROMER, BENJAMIN MATTHEW (MS, CCC/SLP)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:MATTHEW
Last Name:CROMER
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 1:1520 SHERWOOD FOREST ST APT 318
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-3826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1520 SHERWOOD FOREST ST APT 318
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-3826
Practice Address - Country:US
Practice Address - Phone:713-855-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105598OtherTEXAS BOARD OF SPEECH LANGUAGE PATHOLOGY
TX12130921OtherAMERICAN SPEECH LANGUAGE AND HEARING ASSOCIATION