Provider Demographics
NPI:1285883744
Name:CROUCH, LISA ANNE (MA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:CROUCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 WILLIAM POPE DR
Mailing Address - Street 2:SUNGATE MEDICAL CENTER
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7549
Mailing Address - Country:US
Mailing Address - Phone:843-842-2020
Mailing Address - Fax:843-705-1512
Practice Address - Street 1:10 WILLIAM POPE DR
Practice Address - Street 2:SUNGATE MEDICAL CENTER
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7549
Practice Address - Country:US
Practice Address - Phone:843-842-2020
Practice Address - Fax:843-705-1512
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY358231H00000X
SC3996231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist