Provider Demographics
NPI:1457635161
Name:WAUGH, CRYSTAL A (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:A
Last Name:WAUGH
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:A
Other - Last Name:PEYERK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1108 S VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9615
Mailing Address - Country:US
Mailing Address - Phone:989-883-9035
Mailing Address - Fax:
Practice Address - Street 1:1108 S VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9615
Practice Address - Country:US
Practice Address - Phone:989-883-9035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010912841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical