Provider Demographics
NPI:1992152888
Name:POWELL, KRYSTAL (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 TOTTY DR
Mailing Address - Street 2:
Mailing Address - City:HOHENWALD
Mailing Address - State:TN
Mailing Address - Zip Code:38462-2314
Mailing Address - Country:US
Mailing Address - Phone:931-628-5627
Mailing Address - Fax:
Practice Address - Street 1:5010 TROTWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-5074
Practice Address - Country:US
Practice Address - Phone:931-398-6300
Practice Address - Fax:931-840-4402
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist