Provider Demographics
NPI:1053526095
Name:CROUSE, MARY KHANH (CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KHANH
Last Name:CROUSE
Suffix:
Gender:F
Credentials:CCC, SLP
Other - Prefix:
Other - First Name:KHANH
Other - Middle Name:THOAI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC, SLP
Mailing Address - Street 1:11144 FUQUA ST APT 531
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-2551
Mailing Address - Country:US
Mailing Address - Phone:832-646-4834
Mailing Address - Fax:281-922-5113
Practice Address - Street 1:7887 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2013
Practice Address - Country:US
Practice Address - Phone:713-796-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist