Provider Demographics
NPI:1194928309
Name:SCOTT, CRYSTAL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 HOGAN LN
Mailing Address - Street 2:APT. 1203
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7855
Mailing Address - Country:US
Mailing Address - Phone:501-339-0025
Mailing Address - Fax:
Practice Address - Street 1:1601 HOGAN LN
Practice Address - Street 2:APT. 1203
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7855
Practice Address - Country:US
Practice Address - Phone:501-339-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist