Provider Demographics
NPI:1235649344
Name:WARD, CRYSTAL L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:L
Last Name:WARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:L
Other - Last Name:HOPPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1019 WASHINGTON BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3749
Mailing Address - Country:US
Mailing Address - Phone:815-970-5047
Mailing Address - Fax:
Practice Address - Street 1:1010 LAKE ST STE 616
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1136
Practice Address - Country:US
Practice Address - Phone:815-970-5047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0183481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical