Provider Demographics
NPI:1447588116
Name:CRISOSTOMO, SIBYL DGG (MS)
Entity type:Individual
Prefix:MRS
First Name:SIBYL
Middle Name:DGG
Last Name:CRISOSTOMO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 CANADA TOTO RD
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96913-1703
Mailing Address - Country:US
Mailing Address - Phone:671-477-7773
Mailing Address - Fax:671-477-7771
Practice Address - Street 1:770 TOTO CANADA ROAD
Practice Address - Street 2:
Practice Address - City:TOTO
Practice Address - State:GU
Practice Address - Zip Code:96931
Practice Address - Country:US
Practice Address - Phone:671-477-7773
Practice Address - Fax:671-477-7773
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUSLP002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist