Basic Information
| Provider Information | |||||||||
| NPI: | 1982802575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAE | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS-SLP-CCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7681 FM 1026 | ||||||||
| Address2: | |||||||||
| City: | GOULDBUSK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3253574643 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2500 SONG BIRD CIR | ||||||||
| Address2: | |||||||||
| City: | BROWNWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768016488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256464750 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 102638 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.