Provider Demographics
NPI:1861612822
Name:SARGENT, CRYSTAL I (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:I
Last Name:SARGENT
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 1:575 E MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5288
Mailing Address - Country:US
Mailing Address - Phone:401-848-5378
Mailing Address - Fax:401-847-9493
Practice Address - Street 1:575 E MAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5288
Practice Address - Country:US
Practice Address - Phone:401-848-5378
Practice Address - Fax:401-847-9493
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist