Provider Demographics
NPI:1457885196
Name:CRUMPTON, CORITA NADINE
Entity Type:Individual
Prefix:MS
First Name:CORITA
Middle Name:NADINE
Last Name:CRUMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 N OAKLEY LN APT 108
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-6110
Mailing Address - Country:US
Mailing Address - Phone:773-573-8587
Mailing Address - Fax:630-568-5586
Practice Address - Street 1:1032 N OAKLEY LN APT 108
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6110
Practice Address - Country:US
Practice Address - Phone:773-573-8587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA999999OtherCHILD CARE SCHOOL FOR CHILDREN WITH AUTISM