Provider Demographics
NPI:1255498465
Name:OSWALT, CRYSTAL L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:L
Last Name:OSWALT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-2125
Mailing Address - Country:US
Mailing Address - Phone:419-586-3900
Mailing Address - Fax:419-586-3338
Practice Address - Street 1:316 W MARKET ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-2125
Practice Address - Country:US
Practice Address - Phone:419-586-3900
Practice Address - Fax:419-586-3338
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3620103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOSCP04721Medicare ID - Type Unspecified