Provider Demographics
NPI:1063618288
Name:LOWERY, CRAIG HOLT (MA, CCC-SP)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:HOLT
Last Name:LOWERY
Suffix:
Gender:M
Credentials:MA, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17110 ARDATH AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-2908
Mailing Address - Country:US
Mailing Address - Phone:310-293-7217
Mailing Address - Fax:
Practice Address - Street 1:5971 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1713
Practice Address - Country:US
Practice Address - Phone:323-857-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist