Provider Demographics
NPI:1700449758
Name:ZEIGLER, CRYSTAL ANITA
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANITA
Last Name:ZEIGLER
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 1:535 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5508
Mailing Address - Country:US
Mailing Address - Phone:803-665-0445
Mailing Address - Fax:
Practice Address - Street 1:1979 LAKESIDE PKWY STE 800
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5856
Practice Address - Country:US
Practice Address - Phone:808-849-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty