Provider Demographics
NPI:1790114874
Name:WOLFSKILL, CRYSTAL (RDN)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:WOLFSKILL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12023 TRAMPE HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-2659
Mailing Address - Country:US
Mailing Address - Phone:314-438-9860
Mailing Address - Fax:
Practice Address - Street 1:12023 TRAMPE HEIGHTS LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-2659
Practice Address - Country:US
Practice Address - Phone:314-438-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO892292133V00000X
IL164005265133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered