Healthcare Provider Details

I. General information

NPI: 1184538571
Provider Name (Legal Business Name): CRYSTAL REKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 LEDWARD AVE
WESTERLY RI
02891-2510
US

IV. Provider business mailing address

77 LEDWARD AVE
WESTERLY RI
02891-2510
US

V. Phone/Fax

Practice location:
  • Phone: 401-363-6421
  • Fax:
Mailing address:
  • Phone: 401-363-6421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP02087
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: