Provider Demographics
NPI:1699201400
Name:SEALS, CRYSTAL (LSW)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:SEALS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5165 ARQUILLA DR
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-1517
Mailing Address - Country:US
Mailing Address - Phone:773-710-6641
Mailing Address - Fax:
Practice Address - Street 1:5165 ARQUILLA DR
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-1517
Practice Address - Country:US
Practice Address - Phone:773-710-6641
Practice Address - Fax:312-564-5253
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150102350104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker