Provider Demographics
NPI:1023827037
Name:DENTON, CRYSTAL M (MAT, M ED, SE, ECSE)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:DENTON
Suffix:
Gender:F
Credentials:MAT, M ED, SE, ECSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-4233
Mailing Address - Country:US
Mailing Address - Phone:708-320-1815
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1233
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-4233
Practice Address - Country:US
Practice Address - Phone:773-426-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist