Provider Demographics
NPI:1689820201
Name:ZGELA, CRYSTAL EMMALINE (MS, CCC-SLP, LSLS)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:EMMALINE
Last Name:ZGELA
Suffix:
Gender:F
Credentials:MS, CCC-SLP, LSLS
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:EMMALINE
Other - Last Name:CHRISTOPHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:BOX 272 LURIE CHILDREN'S HOSPITAL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:414-810-6301
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:BOX 272 LURIE CHILDREN'S HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:414-810-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3115154235Z00000X
IL146.011207235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42593500Medicaid