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General NPI Number Information
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NPI Number | 1295772770
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Entity Type | Individual
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Provider Name | CRYSTAL MIYAKE MSCCCA
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Gender | Female
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 3099 RIVER RD S STE 150
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City | SALEM
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State | OR
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Zip | 97302-9754
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Country | US
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Telephone | 503-485-2581
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Fax | 503-485-2564
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Provider Business Mailing Address
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Address Line | 3099 RIVER RD S STE 150
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City | SALEM
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State | OR
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Zip | 97302-9754
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Country | US
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Telephone | 503-485-2581
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Fax | 503-485-2564
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | LD00004248
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 022558
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License Number State | OR
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