Healthcare Provider Details

I. General information

NPI: 1669631990
Provider Name (Legal Business Name): CRYSTAL LEANN DURAWA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL LEANN SCHAFEC SPEECH LANGUAGE PATH

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

IV. Provider business mailing address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

V. Phone/Fax

Practice location:
  • Phone: 916-688-2096
  • Fax:
Mailing address:
  • Phone: 916-709-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP15581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: