Provider Demographics
NPI:1851542476
Name:BEISWENGER, CRYSTAL S
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:S
Last Name:BEISWENGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:S
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2630 S ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-5701
Mailing Address - Country:US
Mailing Address - Phone:317-966-0200
Mailing Address - Fax:317-522-1944
Practice Address - Street 1:2630 S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-5701
Practice Address - Country:US
Practice Address - Phone:317-966-0200
Practice Address - Fax:317-522-1944
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-09-5067103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst