Provider Demographics
NPI:1417263294
Name:BUCKRHAM, CHRYSTAL ALTHEA (SLP)
Entity Type:Individual
Prefix:MISS
First Name:CHRYSTAL
Middle Name:ALTHEA
Last Name:BUCKRHAM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 TOPSAIL COMMON DR APT 105
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7093
Mailing Address - Country:US
Mailing Address - Phone:919-457-8142
Mailing Address - Fax:
Practice Address - Street 1:1010 TOPSAIL COMMON DR APT 105
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7093
Practice Address - Country:US
Practice Address - Phone:919-457-8142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist