MEDICARE: CRYSTAL GESCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	39428	TX

General Provider Information

NPI Number	:	1528560505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL GESCH

Provider Business Mailing Address
First Line	:	519 E TYLER ST
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-3426
Country	:	US
Telephone Number	:	214-282-6062
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N CENTRAL EXPY STE 908
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-5326
Country	:	US
Telephone Number	:	972-235-9155
Fax Number	:	972-421-1833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2018
Last Update Date	:	03/06/2018

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Directions to “ CRYSTAL GESCH ” Practice Location

Language	Start Address	Practice Location

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