Provider Demographics
NPI:1033839808
Name:MATA, KRYSTAL MAY (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MAY
Last Name:MATA
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 BABCOCK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4412
Mailing Address - Country:US
Mailing Address - Phone:210-614-3911
Mailing Address - Fax:210-625-3162
Practice Address - Street 1:2203 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4412
Practice Address - Country:US
Practice Address - Phone:210-614-3911
Practice Address - Fax:210-625-3162
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111687235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist