Provider Demographics
NPI:1730496456
Name:MCKOIN, CRYSTAL M (SPEECH)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:M
Last Name:MCKOIN
Suffix:
Gender:F
Credentials:SPEECH
Other - Prefix:MISS
Other - First Name:CRYSTAL
Other - Middle Name:M
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPEECH
Mailing Address - Street 1:10578 CAMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-2502
Mailing Address - Country:US
Mailing Address - Phone:318-283-2080
Mailing Address - Fax:
Practice Address - Street 1:3867 BAYOU ACRES DR
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-9232
Practice Address - Country:US
Practice Address - Phone:318-283-2080
Practice Address - Fax:318-283-0606
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist