Provider Demographics
NPI:1710171764
Name:JOSEPH, CRYSTAL D (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11555 SOUTHFORK AVE APT 1090
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2267
Mailing Address - Country:US
Mailing Address - Phone:281-507-7382
Mailing Address - Fax:
Practice Address - Street 1:535 W ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-7844
Practice Address - Country:US
Practice Address - Phone:225-343-4232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5468237600000X
TX51760237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter