Provider Demographics
NPI:1881079424
Name:SANDOVAL, KRYSTAL (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 TEATRO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5691
Mailing Address - Country:US
Mailing Address - Phone:210-995-3454
Mailing Address - Fax:
Practice Address - Street 1:3355 CHERRY RIDGE ST
Practice Address - Street 2:STE. 218
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4815
Practice Address - Country:US
Practice Address - Phone:210-614-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist