Provider Demographics
NPI:1689990285
Name:CHAMPION, CRYSTAL DAWN (PHD)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:DAWN
Last Name:CHAMPION
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 1:1725 STATE ST
Mailing Address - Street 2:COUNSELING AND TESTING CENTER
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3742
Mailing Address - Country:US
Mailing Address - Phone:608-785-8073
Mailing Address - Fax:608-785-8965
Practice Address - Street 1:1725 STATE ST
Practice Address - Street 2:COUNSELING AND TESTING CENTER
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3742
Practice Address - Country:US
Practice Address - Phone:608-785-8073
Practice Address - Fax:608-785-8965
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist