Provider Demographics
NPI:1073532628
Name:KJAR, CRYSTAL DAWN (ATC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DAWN
Last Name:KJAR
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 BRUMMOND DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5826
Mailing Address - Country:US
Mailing Address - Phone:402-202-3184
Mailing Address - Fax:
Practice Address - Street 1:7001 S 14TH ST
Practice Address - Street 2:LINCOLN SOUTHWEST HIGH SCHOOL
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9200
Practice Address - Country:US
Practice Address - Phone:402-436-1306
Practice Address - Fax:402-436-1875
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer