Provider Demographics
NPI:1861425019
Name:JETT, CRYSTAL (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:JETT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-7236
Mailing Address - Country:US
Mailing Address - Phone:843-260-2404
Mailing Address - Fax:
Practice Address - Street 1:2330 JULIE ANN DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6361
Practice Address - Country:US
Practice Address - Phone:843-665-1870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3955235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist