Provider Demographics
NPI:1174890719
Name:THOMAS, CRYSTAL MICHELLE (M S, CF/SLP)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:MICHELLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:M S, CF/SLP
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:MICHELLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:22190 E 7TH PL APT 2-301
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-4725
Mailing Address - Country:US
Mailing Address - Phone:606-364-4556
Mailing Address - Fax:
Practice Address - Street 1:52 N ROBERTSDALE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80018-1899
Practice Address - Country:US
Practice Address - Phone:303-364-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
KY11-083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty