Provider Demographics
NPI:1467501684
Name:BRASWELL, CRYSTAL GAIL (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:GAIL
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4199 BIZZELL GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NC
Mailing Address - Zip Code:27569-9465
Mailing Address - Country:US
Mailing Address - Phone:919-631-1440
Mailing Address - Fax:919-989-3110
Practice Address - Street 1:4199 BIZZELL GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NC
Practice Address - Zip Code:27569-9465
Practice Address - Country:US
Practice Address - Phone:919-631-1440
Practice Address - Fax:919-989-3110
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7329235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412554Medicaid