Provider Demographics
NPI:1245651041
Name:KNIGHT, CRYSTAL D (MS SLP)
Entity type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:D
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-6406
Mailing Address - Country:US
Mailing Address - Phone:318-664-7869
Mailing Address - Fax:
Practice Address - Street 1:1804 MACARTHUR DR
Practice Address - Street 2:SUITE 410
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3758
Practice Address - Country:US
Practice Address - Phone:318-466-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6337OtherLBESPA