Provider Demographics
NPI:1043550882
Name:CONWAY, CRYSTAL (MS)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 DARBY DR
Mailing Address - Street 2:#205
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-1750
Mailing Address - Country:US
Mailing Address - Phone:360-714-8360
Mailing Address - Fax:
Practice Address - Street 1:124 E LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2914
Practice Address - Country:US
Practice Address - Phone:360-428-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI60327205235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist