Provider Demographics
NPI:1225821713
Name:NIELSEN, CRYSTAL ANN (EDS, MA, PPS)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:EDS, MA, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35320 DAGGETT YERMO RD
Mailing Address - Street 2:
Mailing Address - City:YERMO
Mailing Address - State:CA
Mailing Address - Zip Code:92398-0408
Mailing Address - Country:US
Mailing Address - Phone:760-254-1358
Mailing Address - Fax:
Practice Address - Street 1:35320 DAGGETT YERMO RD
Practice Address - Street 2:
Practice Address - City:YERMO
Practice Address - State:CA
Practice Address - Zip Code:92398-0408
Practice Address - Country:US
Practice Address - Phone:760-254-1358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool