Provider Demographics
NPI:1659637650
Name:CRYSTAL SPEECH AND LANGUAGE PATHOLOGY PLLC
Entity Type:Organization
Organization Name:CRYSTAL SPEECH AND LANGUAGE PATHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATSLAVSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:CCC SLP
Authorized Official - Phone:917-981-0034
Mailing Address - Street 1:2012 JEROME AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3215
Mailing Address - Country:US
Mailing Address - Phone:917-981-0034
Mailing Address - Fax:
Practice Address - Street 1:2012 JEROME AVE APT 4A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3215
Practice Address - Country:US
Practice Address - Phone:917-981-0034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020327251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health