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Individual

CRYSTAL ROSE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S., CCC-SLP

Contact information

Practice address
1483 SW BOUGAINVILLEA AVE, PORT ST LUCIE, FL 34953-7302
(772) 337-4208
Mailing address
771 SW GENERAL PATTON TER, PORT ST LUCIE, FL 34953-2657
(772) 607-1282

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA20372
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
SA20372
DEPARTMENT OF HEALTH - LICENSE
FL
Enumeration date
08/09/2021
Last updated
08/29/2022
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