Provider Demographics
NPI:1457478885
Name:SCOTT, CRYSTAL DAWN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:DAWN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:DAWN
Other - Last Name:FELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14903 WINDSOR LN
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4711
Mailing Address - Country:US
Mailing Address - Phone:317-773-9080
Mailing Address - Fax:317-776-9016
Practice Address - Street 1:14903 WINDSOR LN
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4711
Practice Address - Country:US
Practice Address - Phone:317-773-9080
Practice Address - Fax:317-776-9016
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003261A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22003261AOtherSPEECH PATHOLOGIST LICENS
IN200603290Medicaid
12023416OtherASHA LICENSE #