Provider Demographics
NPI:1538440318
Name:KRISTALL-SCLAR, ANITA JOY (MS CCC-SP)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:JOY
Last Name:KRISTALL-SCLAR
Suffix:
Gender:F
Credentials:MS CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-9762
Mailing Address - Country:US
Mailing Address - Phone:315-637-8549
Mailing Address - Fax:
Practice Address - Street 1:5010 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-9762
Practice Address - Country:US
Practice Address - Phone:315-637-8549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58003438235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist