Provider Demographics
NPI:1932726767
Name:GEMBALA SEHR, CRYSTALYN (MSOM)
Entity Type:Individual
Prefix:
First Name:CRYSTALYN
Middle Name:
Last Name:GEMBALA SEHR
Suffix:
Gender:F
Credentials:MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 E HIGGINS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1563
Mailing Address - Country:US
Mailing Address - Phone:847-696-6280
Mailing Address - Fax:847-257-7447
Practice Address - Street 1:1191 E HIGGINS RD STE 201
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-1563
Practice Address - Country:US
Practice Address - Phone:847-696-6280
Practice Address - Fax:847-257-7447
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001496171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist