Provider Demographics
NPI:1134665763
Name:SALAS, CRYSTAL ADELINA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ADELINA
Last Name:SALAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 56TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3016
Mailing Address - Country:US
Mailing Address - Phone:631-639-8389
Mailing Address - Fax:
Practice Address - Street 1:820 HANCOCK ST
Practice Address - Street 2:RM. 408
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1309
Practice Address - Country:US
Practice Address - Phone:718-218-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist