Provider Demographics
NPI:1629945845
Name:BELK, CRYSTAL DIOR ANTWANETTE
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:DIOR ANTWANETTE
Last Name:BELK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-2635
Mailing Address - Country:US
Mailing Address - Phone:312-371-4024
Mailing Address - Fax:
Practice Address - Street 1:3519 CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1044
Practice Address - Country:US
Practice Address - Phone:312-371-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-22
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty