Provider Demographics
NPI:1689817355
Name:MIGLIORISI, CRYSTAL (CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:MIGLIORISI
Suffix:
Gender:F
Credentials:CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:GUERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4221
Mailing Address - Country:US
Mailing Address - Phone:646-641-1794
Mailing Address - Fax:
Practice Address - Street 1:135 PENN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4221
Practice Address - Country:US
Practice Address - Phone:646-641-1794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018989-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist