Provider Demographics
NPI:1881027985
Name:SIMS, CRYSTAL S (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:S
Last Name:SIMS
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W STEWART ST
Mailing Address - Street 2:
Mailing Address - City:PELZER
Mailing Address - State:SC
Mailing Address - Zip Code:29669-1126
Mailing Address - Country:US
Mailing Address - Phone:864-947-6424
Mailing Address - Fax:864-947-2014
Practice Address - Street 1:10 W STEWART ST
Practice Address - Street 2:
Practice Address - City:PELZER
Practice Address - State:SC
Practice Address - Zip Code:29669-1126
Practice Address - Country:US
Practice Address - Phone:864-947-6424
Practice Address - Fax:864-947-2014
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2770251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1104973577Medicaid