Provider Demographics
NPI:1326266339
Name:SIMPSON, KRYSTAL R (EDD CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:R
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:EDD 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:P.O. BOX 466
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD HTS
Mailing Address - State:IN
Mailing Address - Zip Code:46346-0466
Mailing Address - Country:US
Mailing Address - Phone:219-814-6303
Mailing Address - Fax:
Practice Address - Street 1:504 UPLAND ROAD
Practice Address - Street 2:
Practice Address - City:KINGSFORD HTS
Practice Address - State:IN
Practice Address - Zip Code:46346-0466
Practice Address - Country:US
Practice Address - Phone:219-814-6303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003555A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist