Provider Demographics
NPI:1326779604
Name:KRYSTAL CLEAR HEARING CENTER PLLC
Entity Type:Organization
Organization Name:KRYSTAL CLEAR HEARING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:701-483-6500
Mailing Address - Street 1:1674 15TH ST W STE A
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-2810
Mailing Address - Country:US
Mailing Address - Phone:701-483-6500
Mailing Address - Fax:
Practice Address - Street 1:1674 15TH ST W STE A
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2810
Practice Address - Country:US
Practice Address - Phone:701-483-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty