Basic Information
| Provider Information | |||||||||
| NPI: | 1972701365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CROSSROADS SPEECH & HEARING, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CROSSROADS SPEECH AND HEARING, INC. | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3240 WASHINGTON RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MCMURRAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153173180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249414434 | ||||||||
| FaxNumber: | 7249414714 | ||||||||
| Practice Location | |||||||||
| Address1: | 3240 WASHINGTON RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MCMURRAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153173180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249414434 | ||||||||
| FaxNumber: | 7249414714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 12/16/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CONRAD | ||||||||
| AuthorizedOfficialFirstName: | CHRISTIE-ANN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7249414434 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | SLP CCC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | D00392 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 1000033000006 | 05 | PA | MEDICAID |