Provider Demographics
NPI:1801565734
Name:CROSS, NATHANIEL RAY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:RAY
Last Name:CROSS
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 1:487 WICHITA ST
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-6751
Mailing Address - Country:US
Mailing Address - Phone:661-917-0042
Mailing Address - Fax:
Practice Address - Street 1:2301 S BROADWAY AVE STE B10
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5409
Practice Address - Country:US
Practice Address - Phone:903-884-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist