Provider Demographics
NPI:1194378604
Name:KEDROSKE, CRYSTAL MARIE
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:MARIE
Last Name:KEDROSKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 VICTORS WAY STE 30
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-5217
Mailing Address - Country:US
Mailing Address - Phone:844-263-1613
Mailing Address - Fax:
Practice Address - Street 1:950 VICTORS WAY STE 30
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-5217
Practice Address - Country:US
Practice Address - Phone:844-263-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician