Basic Information
| Provider Information | |||||||||
| NPI: | 1083819841 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN-JACKSON | ||||||||
| FirstName: | KRYSTAL | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13617 DREXMORE RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441202203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162619600 | ||||||||
| FaxNumber: | 2162619662 | ||||||||
| Practice Location | |||||||||
| Address1: | 15600 PARKLAND DR | ||||||||
| Address2: | |||||||||
| City: | SHAKER HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162951400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 06/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP8161 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.