Healthcare Provider Details

I. General information

NPI: 1487587812
Provider Name (Legal Business Name): CRYSTAL OWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ROSENWALD LN
BREVARD NC
28712-5211
US

IV. Provider business mailing address

686 BREEDLOVE RD
LAKE TOXAWAY NC
28747-8687
US

V. Phone/Fax

Practice location:
  • Phone: 828-884-6173
  • Fax:
Mailing address:
  • Phone: 828-553-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12703
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: