Provider Demographics
NPI:1588806533
Name:BUEHRE, CRYSTAL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BUEHRE
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:PO BOX 1666
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-1666
Mailing Address - Country:US
Mailing Address - Phone:573-434-6699
Mailing Address - Fax:573-365-7143
Practice Address - Street 1:690 MISSOURI AVE STE 11
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-4680
Practice Address - Country:US
Practice Address - Phone:573-336-1970
Practice Address - Fax:573-365-7143
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK168829235Z00000X
VA2202009887235Z00000X
MO20080235336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO466573805Medicaid