Provider Demographics
NPI:1457744138
Name:MEISSNER, CRYSTA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CRYSTA
Middle Name:
Last Name:MEISSNER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CRYSTA
Other - Middle Name:
Other - Last Name:MAURER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:110 E HURON AVE
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-1312
Mailing Address - Country:US
Mailing Address - Phone:989-430-6080
Mailing Address - Fax:989-269-7666
Practice Address - Street 1:110 E HURON AVE
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1312
Practice Address - Country:US
Practice Address - Phone:989-430-6080
Practice Address - Fax:989-269-7666
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000128235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist