Provider Demographics
NPI:1265669501
Name:PRATT, KRYSTAL SHAUNTEL (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:SHAUNTEL
Last Name:PRATT
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 1:2660 HOLLY HALL ST APT C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4190
Mailing Address - Country:US
Mailing Address - Phone:281-300-5526
Mailing Address - Fax:866-357-6349
Practice Address - Street 1:2660 HOLLY HALL ST APT C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4190
Practice Address - Country:US
Practice Address - Phone:281-300-5526
Practice Address - Fax:866-357-6349
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-13
Last Update Date:2009-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103798235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist