Individual
AMIRA GABRIELLE CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7600 ARLINGTON RD, BETHESDA, MD 20814-6200
(240) 204-5300
Mailing address
1464 S GREENMOUNT DR APT 309, ALEXANDRIA, VA 22311-2328
(301) 266-2386
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
08200
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08200
—
MD
Enumeration date
04/05/2019
Last updated
04/05/2019
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