Provider Demographics
NPI:1336928191
Name:DURAN, KRYSTAL KATHLEEN
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:KATHLEEN
Last Name:DURAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 W TIERRA BUENA LN UNIT 222
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3876
Mailing Address - Country:US
Mailing Address - Phone:480-258-7032
Mailing Address - Fax:
Practice Address - Street 1:6250 W DURANGO ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-6580
Practice Address - Country:US
Practice Address - Phone:623-707-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA142902355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant