Provider Demographics
NPI:1437669785
Name:ARCHIBALD, KRYSTAL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:ARCHIBALD
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 1:3710 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3426
Mailing Address - Country:US
Mailing Address - Phone:440-376-8407
Mailing Address - Fax:
Practice Address - Street 1:3710 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3426
Practice Address - Country:US
Practice Address - Phone:440-376-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-01
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17112235Z00000X
FLSZ8355390200000X
OHSP13827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program