Provider Demographics
NPI:1235952565
Name:HUGHES, CRYSTAL LEE (PWS, CRM)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PWS, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3416
Mailing Address - Country:US
Mailing Address - Phone:541-756-3111
Mailing Address - Fax:541-756-2111
Practice Address - Street 1:1950 WAITE ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-1228
Practice Address - Country:US
Practice Address - Phone:541-756-3111
Practice Address - Fax:541-808-3134
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW00000112469175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist