Provider Demographics
NPI:1699108324
Name:CROUSE, CARRIE BETH (MS/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:BETH
Last Name:CROUSE
Suffix:
Gender:F
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 1:915 HERITAGE PL
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4691
Mailing Address - Country:US
Mailing Address - Phone:270-293-5250
Mailing Address - Fax:
Practice Address - Street 1:915 HERITAGE PL
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4691
Practice Address - Country:US
Practice Address - Phone:270-293-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist