Provider Demographics
NPI:1497336481
Name:COMFORT, CRYSTA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CRYSTA
Middle Name:
Last Name:COMFORT
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 1:520 BELLA VISTA CT S
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5504
Mailing Address - Country:US
Mailing Address - Phone:561-373-7729
Mailing Address - Fax:
Practice Address - Street 1:12300 ALTERNATE A1A STE 108
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2206
Practice Address - Country:US
Practice Address - Phone:561-248-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist