Provider Demographics
NPI:1093517435
Name:SCHIESS, KRYSTAL L (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:L
Last Name:SCHIESS
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4852 COLE ST
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2931
Mailing Address - Country:US
Mailing Address - Phone:208-705-2231
Mailing Address - Fax:
Practice Address - Street 1:1295 ALPINE AVE
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-3100
Practice Address - Country:US
Practice Address - Phone:208-232-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDTSLP-5979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist