Provider Demographics
NPI:1194029876
Name:OSWALD, KRYSTAL MARIE (BCBA, LSW)
Entity type:Individual
Prefix:MISS
First Name:KRYSTAL
Middle Name:MARIE
Last Name:OSWALD
Suffix:
Gender:F
Credentials:BCBA, LSW
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:MARIE
Other - Last Name:RHINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5801 MOUNT PLEASANT LN
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-3944
Mailing Address - Country:US
Mailing Address - Phone:618-489-5102
Mailing Address - Fax:
Practice Address - Street 1:5801 MOUNT PLEASANT LN
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3944
Practice Address - Country:US
Practice Address - Phone:618-489-5102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152.001327103K00000X
MO023005308103K00000X
IL150.114174104100000X
1-17-26500103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker