Provider Demographics
NPI:1457849648
Name:KING, CHRYSTAL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:
Last Name:KING
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 1:325 E SANTA ANITA AVE APT 222
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1457
Mailing Address - Country:US
Mailing Address - Phone:818-404-1624
Mailing Address - Fax:
Practice Address - Street 1:611 N BRAND BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3240
Practice Address - Country:US
Practice Address - Phone:747-286-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
CASP25134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist