Provider Demographics
NPI:1568711315
Name:CRYSTAL, SARAH INGRID (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:INGRID
Last Name:CRYSTAL
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 1:2409 29TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-3321
Mailing Address - Country:US
Mailing Address - Phone:617-816-1814
Mailing Address - Fax:
Practice Address - Street 1:221 1ST AVE W STE 216
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4223
Practice Address - Country:US
Practice Address - Phone:971-708-1788
Practice Address - Fax:617-816-1814
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60884393103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist