Provider Demographics
NPI:1134973092
Name:PEARSALL, CRYSTAL KAY (CRM II)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:KAY
Last Name:PEARSALL
Suffix:
Gender:F
Credentials:CRM II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3513
Mailing Address - Country:US
Mailing Address - Phone:458-240-5888
Mailing Address - Fax:
Practice Address - Street 1:146 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3513
Practice Address - Country:US
Practice Address - Phone:458-240-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-CRM-II-0168175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist