Individual
CRYSTAL BLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PEER SUPPORT
Contact information
Practice address
4977 NORTHCUTT PL, DAYTON, OH 45414-3839
(800) 829-5461
Mailing address
5512 FISHER DR, DAYTON, OH 45424-5528
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
APS005618
OH
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
About Stedi
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