Provider Demographics
NPI:1225715253
Name:THE KRYSTAL CLEAR GROUP, INC.
Entity Type:Organization
Organization Name:THE KRYSTAL CLEAR GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCC-SLP
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SENNET
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:210-926-9975
Mailing Address - Street 1:8027 SUNSHINE TOWER DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1858
Mailing Address - Country:US
Mailing Address - Phone:210-926-9975
Mailing Address - Fax:
Practice Address - Street 1:8027 SUNSHINE TOWER DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1858
Practice Address - Country:US
Practice Address - Phone:210-926-9975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty