Provider Demographics
NPI:1114303419
Name:OSBORN, KRYSTAL (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:OSBORN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 SWAN LAKE DR
Mailing Address - Street 2:203
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-7265
Mailing Address - Country:US
Mailing Address - Phone:740-856-9012
Mailing Address - Fax:
Practice Address - Street 1:250 PANTOPS MOUNTAIN RD
Practice Address - Street 2:REHABILITATION DEPARTMENT
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8686
Practice Address - Country:US
Practice Address - Phone:434-972-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist