Provider Demographics
NPI:1982802575
Name:RAE, CRYSTAL MICHELLE (MS-SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:MICHELLE
Last Name:RAE
Suffix:
Gender:F
Credentials:MS-SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7681 FM 1026
Mailing Address - Street 2:
Mailing Address - City:GOULDBUSK
Mailing Address - State:TX
Mailing Address - Zip Code:76845
Mailing Address - Country:US
Mailing Address - Phone:325-357-4643
Mailing Address - Fax:
Practice Address - Street 1:2500 SONG BIRD CIR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-6488
Practice Address - Country:US
Practice Address - Phone:325-646-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist