Healthcare Provider Details

I. General information

NPI: 1861993834
Provider Name (Legal Business Name): CRYSTAL ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY
JACKSONVILLE FL
32216-6282
US

IV. Provider business mailing address

1673 LA MADERIA DR SW
PALM BAY FL
32908-1118
US

V. Phone/Fax

Practice location:
  • Phone: 904-945-7556
  • Fax:
Mailing address:
  • Phone: 321-576-8867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI5197
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: