Krystal Klear Speech Services

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

KRYSTAL KLEAR SPEECH SERVICES

Practice address

4075 Demooney Rd
College Park, GA 30349-1312

Phone

(404) 520-0087

NPI assigned

Nov 19, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Krystal Gambrell

Title

Owner/Ceo

Phone

(404) 520-0087

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608508800000",
    "number": "1477199073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4075 DEMOONEY RD",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303491312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4075 DEMOONEY RD",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303491312",
            "telephone_number": "404-520-0087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRYSTAL KLEAR SPEECH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-19",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A",
        "authorized_official_last_name": "GAMBRELL",
        "authorized_official_first_name": "KRYSTAL",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "404-520-0087"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629370853",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in College Park, GA
• Providers in College Park, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.