Provider Demographics
NPI:1942682919
Name:SEBRING, CRYSTAL (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:SEBRING
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:JEFFERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:8832 DOME CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8560
Mailing Address - Country:US
Mailing Address - Phone:575-910-7227
Mailing Address - Fax:
Practice Address - Street 1:8832 DOME CIR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8560
Practice Address - Country:US
Practice Address - Phone:575-910-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP6046235Z00000X
AK124313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14084151OtherAMERICAN SPEECH-LANGUAGE & HEARING ASSOCIATION