Provider Demographics
NPI:1962835520
Name:EASTER, CRYSTAL LYN (MS CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LYN
Last Name:EASTER
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 NW 86TH AVE
Mailing Address - Street 2:APT 824
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1260
Mailing Address - Country:US
Mailing Address - Phone:573-231-1802
Mailing Address - Fax:
Practice Address - Street 1:880 NW 86TH AVE
Practice Address - Street 2:APT 824
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1260
Practice Address - Country:US
Practice Address - Phone:573-231-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist