Provider Demographics
NPI:1841735313
Name:ESTRADA, CRYSTAL (AAS-SLP-ASSISSTANT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:AAS-SLP-ASSISSTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 SUNNYFIELD CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-9380
Mailing Address - Country:US
Mailing Address - Phone:919-240-5437
Mailing Address - Fax:919-537-8093
Practice Address - Street 1:2415 SUNNYFIELD CT
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9380
Practice Address - Country:US
Practice Address - Phone:919-240-5437
Practice Address - Fax:919-537-8093
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01612355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant