1730845157 NPI number — CRYSTAL LYNN VANKAUWENBERG LPC

Table of content: CRYSTAL LYNN VANKAUWENBERG LPC (NPI 1730845157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730845157 NPI number — CRYSTAL LYNN VANKAUWENBERG LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANKAUWENBERG
Provider First Name:
CRYSTAL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HELLING
Provider Other First Name:
CRYSTAL
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730845157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22040
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54305-2040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-445-7222
Provider Business Mailing Address Fax Number:
920-445-7289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 ANGELS PATH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DE PERE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54115-4050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-338-2855
Provider Business Practice Location Address Fax Number:
920-338-9270
Provider Enumeration Date:
11/10/2021

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: 101YP2500X , with the licence number:  8188-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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