Provider Demographics
NPI:1801105192
Name:BATES, CRYSTAL ANN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ANN
Last Name:BATES
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:ANN
Other - Last Name:TALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:61465 WAKEFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725
Mailing Address - Country:US
Mailing Address - Phone:740-297-0396
Mailing Address - Fax:419-447-5577
Practice Address - Street 1:61465 WAKEFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725
Practice Address - Country:US
Practice Address - Phone:740-297-0396
Practice Address - Fax:614-834-4410
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2011084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist