Provider Demographics
NPI:1962819029
Name:CRESPO, MISTY WILLIAMSON (HIS)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:WILLIAMSON
Last Name:CRESPO
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:LEDAWN
Other - Last Name:WILLIAMSON CRESPO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8123
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:978-313-6824
Practice Address - Street 1:100 VERDE VALLEY SCHOOL RD STE 105
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-9053
Practice Address - Country:US
Practice Address - Phone:928-284-5200
Practice Address - Fax:928-284-5201
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHAD.0000284237700000X
GAHADS000922237700000X
AZHADR10832237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist