Provider Demographics
NPI:1972798189
Name:CROWE, CRYSTAL (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:CROWE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:199 N BROOKMOORE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2024
Mailing Address - Country:US
Mailing Address - Phone:662-327-6705
Mailing Address - Fax:662-869-9980
Practice Address - Street 1:960 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-9762
Practice Address - Country:US
Practice Address - Phone:662-260-3798
Practice Address - Fax:662-260-3790
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist