Healthcare Provider Details

I. General information

NPI: 1982238127
Provider Name (Legal Business Name): CRYSTAL HEARING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/16/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16251 N CLEVELAND AVE STE 8
NORTH FORT MYERS FL
33903-2176
US

IV. Provider business mailing address

16251 N CLEVELAND AVE STE 8
NORTH FORT MYERS FL
33903-2176
US

V. Phone/Fax

Practice location:
  • Phone: 239-997-8288
  • Fax: 239-997-8084
Mailing address:
  • Phone: 239-997-8288
  • Fax: 239-997-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CRYSTAL MARIE BROUSSARD
Title or Position: DOCTOR OF AUDIOLOGY/OWNER
Credential: AU.D.
Phone: 239-997-8288