Provider Demographics
NPI:1194371245
Name:COX, CRYSTAL S (MS)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:S
Last Name:COX
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 YOUNG ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-5438
Mailing Address - Country:US
Mailing Address - Phone:252-290-8357
Mailing Address - Fax:
Practice Address - Street 1:3700 ROSS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5632
Practice Address - Country:US
Practice Address - Phone:972-925-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20934235Z00000X
TX115953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120085901Medicaid
NCW4004-16283OtherAETNA