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General NPI Number Information
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NPI Number | 1861993834
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Entity Type | Individual
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Provider Name | CRYSTAL ALLEN
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Gender | Female
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 6817 SOUTHPOINT PKWY
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6282
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Country | US
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Telephone | 904-945-7556
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Fax |
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Provider Business Mailing Address
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Address Line | 1673 LA MADERIA DR SW
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City | PALM BAY
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State | FL
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Zip | 32908-1118
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Country | US
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Telephone | 321-576-8867
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SI5197
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License Number State | FL
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