Provider Demographics
NPI:1124528641
Name:CANTU, KRYSTLE (SLP-ASSISTANT)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:
Last Name:CANTU
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6734 FOREST MEWS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-1561
Mailing Address - Country:US
Mailing Address - Phone:832-274-7363
Mailing Address - Fax:
Practice Address - Street 1:6734 FOREST MEWS CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-1561
Practice Address - Country:US
Practice Address - Phone:832-274-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist