Provider Demographics
NPI:1063234623
Name:CROCKER, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CROCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 S FERDON BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-5481
Mailing Address - Country:US
Mailing Address - Phone:850-203-2877
Mailing Address - Fax:850-669-2848
Practice Address - Street 1:5941 BERRYHILL ROAD STE K
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570
Practice Address - Country:US
Practice Address - Phone:850-564-5820
Practice Address - Fax:850-564-4507
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2369237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist