Provider Demographics
NPI:1063726545
Name:ALONZO, CRYSTLE NICOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CRYSTLE
Middle Name:NICOLE
Last Name:ALONZO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CRYSTLE
Other - Middle Name:NICOLE
Other - Last Name:ALAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1096 AVENIDA SEVILLE
Mailing Address - Street 2:
Mailing Address - City:RIO RICO
Mailing Address - State:AZ
Mailing Address - Zip Code:85648-1664
Mailing Address - Country:US
Mailing Address - Phone:520-860-0255
Mailing Address - Fax:
Practice Address - Street 1:3036 N BOLDT DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-0960
Practice Address - Country:US
Practice Address - Phone:928-773-0895
Practice Address - Fax:928-773-0896
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP6783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist