Provider Demographics
NPI:1104132083
Name:POPE, CRYSTEN ANN LOUISE (MSCCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CRYSTEN
Middle Name:ANN LOUISE
Last Name:POPE
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 LATIGO CIR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3489
Mailing Address - Country:US
Mailing Address - Phone:575-317-7951
Mailing Address - Fax:
Practice Address - Street 1:1511 LATIGO CIR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201
Practice Address - Country:US
Practice Address - Phone:575-317-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-4738235Z00000X
NM4903235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist