Provider Demographics
NPI: | 1942207808 |
---|---|
Name: | CAUSER, CRYSTAL KAYE (AUD) |
Entity Type: | Individual |
Prefix: | |
First Name: | CRYSTAL |
Middle Name: | KAYE |
Last Name: | CAUSER |
Suffix: | |
Gender: | F |
Credentials: | AUD |
Other - Prefix: | |
Other - First Name: | CRYSTAL |
Other - Middle Name: | KAYE |
Other - Last Name: | DEACON |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | AUD |
Mailing Address - Street 1: | 501 HOWARD AVE |
Mailing Address - Street 2: | D-203 |
Mailing Address - City: | ALTOONA |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 16601 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 814-946-0721 |
Mailing Address - Fax: | 814-946-0783 |
Practice Address - Street 1: | 501 HOWARD AVE |
Practice Address - Street 2: | D-203 |
Practice Address - City: | ALTOONA |
Practice Address - State: | PA |
Practice Address - Zip Code: | 16601 |
Practice Address - Country: | US |
Practice Address - Phone: | 814-946-0721 |
Practice Address - Fax: | 814-946-0783 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-07-06 |
Last Update Date: | 2014-05-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | AT000900L | 231H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | DE234771 | Other | BLUE CROSS |
PA | 0018635550004 | Medicaid | |
PA | 0018635550001 | Medicaid | |
PA | 048606 | Medicare ID - Type Unspecified | |
PA | 0018635550001 | Medicaid |