Individual
MS. LAURA P CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA SLP
Contact information
Practice address
7505 COUNTRY CLUB DR, GOLDEN VALLEY, MN 55427-4501
(763) 450-6901
Mailing address
7505 COUNTRY CLUB DR, GOLDEN VALLEY, MN 55427-4501
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8709
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8709
MN STATE LICENSE
MN
Enumeration date
01/18/2011
Last updated
01/18/2011
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