Basic Information
| Provider Information | |||||||||
| NPI: | 1649544206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT HUWYLER | ||||||||
| FirstName: | KRYSTIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7311 SELMA DR | ||||||||
| Address2: | |||||||||
| City: | FENTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484309015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102621510 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1308 WAUKEGAN RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600253070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774864140 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2012 | ||||||||
| LastUpdateDate: | 03/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-12-10389 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.