1689990285 NPI number — MS. CRYSTAL DAWN CHAMPION PH.D.

Table of content: MS. CRYSTAL DAWN CHAMPION PH.D. (NPI 1689990285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689990285 NPI number — MS. CRYSTAL DAWN CHAMPION PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAMPION
Provider First Name:
CRYSTAL
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689990285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1725 STATE ST
Provider Second Line Business Mailing Address:
COUNSELING AND TESTING CENTER
Provider Business Mailing Address City Name:
LA CROSSE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54601-3742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-785-8073
Provider Business Mailing Address Fax Number:
608-785-8965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1725 STATE ST
Provider Second Line Business Practice Location Address:
COUNSELING AND TESTING CENTER
Provider Business Practice Location Address City Name:
LA CROSSE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54601-3742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-785-8073
Provider Business Practice Location Address Fax Number:
608-785-8965
Provider Enumeration Date:
04/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com