Provider Demographics
NPI:1326214115
Name:HAWKINS, CRYSTLE LYN (LMP)
Entity Type:Individual
Prefix:
First Name:CRYSTLE
Middle Name:LYN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 N CHELAN AVE STE A3
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-6622
Mailing Address - Country:US
Mailing Address - Phone:509-663-5101
Mailing Address - Fax:509-662-9104
Practice Address - Street 1:630 N CHELAN AVE STE A3
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6622
Practice Address - Country:US
Practice Address - Phone:509-663-5101
Practice Address - Fax:509-662-9104
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024564225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist