Provider Demographics
NPI:1528192622
Name:SCHWENK, CRYSTAL (MS)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:SCHWENK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12951 BEL RED RD
Mailing Address - Street 2:190
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2644
Mailing Address - Country:US
Mailing Address - Phone:425-462-2776
Mailing Address - Fax:425-462-2860
Practice Address - Street 1:12951 BEL RED RD
Practice Address - Street 2:190
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2644
Practice Address - Country:US
Practice Address - Phone:425-462-2776
Practice Address - Fax:425-462-2860
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 8592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health