Provider Demographics
NPI:1053445262
Name:WILLIAMS, JUSTINE KYCKELHAHN CRAWFORD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:KYCKELHAHN CRAWFORD
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 2ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3139
Mailing Address - Country:US
Mailing Address - Phone:971-212-2696
Mailing Address - Fax:503-588-9424
Practice Address - Street 1:425 2ND ST STE 200
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3139
Practice Address - Country:US
Practice Address - Phone:971-212-2696
Practice Address - Fax:503-588-9424
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1592103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical