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General NPI Number Information
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NPI Number | 1457747727
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Entity Type | Individual
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Provider Name | CRYSTAL PATRICIA BURNETT M.A.
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Gender | Female
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 2985 E PENNY LN
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City | ONTARIO
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State | CA
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Zip | 91761-3901
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Country | US
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Telephone | 909-800-2280
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Fax |
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Provider Business Mailing Address
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Address Line | 2985 E PENNY LN
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City | ONTARIO
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State | CA
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Zip | 91761-3901
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Country | US
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Telephone | 909-800-2280
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Fax |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8978
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22853
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License Number State | CA
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