1598806853 NPI number — MRS. MARILYN THERESA CROWDER-WILE MS CCC-SLP

Table of content: MRS. MARILYN THERESA CROWDER-WILE MS CCC-SLP (NPI 1598806853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598806853 NPI number — MRS. MARILYN THERESA CROWDER-WILE MS CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROWDER-WILE
Provider First Name:
MARILYN
Provider Middle Name:
THERESA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROWDER
Provider Other First Name:
MARILYN
Provider Other Middle Name:
THERESA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS CFY-SLP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1598806853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4104 7TH PL NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55901-8454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-281-3001
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2746 SUPERIOR DR NW
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55901-8343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-288-0064
Provider Business Practice Location Address Fax Number:
507-288-3993
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  6018 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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