Individual
DEBRA CRYSTAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
25 N. WINFIELD RD, WINFIELD, IL 60190
(630) 933-4056
Mailing address
25 N. WINFIELD RD, WINFIELD, IL 60190
(630) 933-4056
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.007431
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE GROUP PTAN
IL
01
—
F400163385
MEDICARE PTAN
IL
Enumeration date
10/24/2006
Last updated
09/19/2014
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