Basic Information
| Provider Information | |||||||||
| NPI: | 1962819029 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRESPO | ||||||||
| FirstName: | MISTY | ||||||||
| MiddleName: | WILLIAMSON | ||||||||
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| Credential: | HIS | ||||||||
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| OtherLastName: | WILLIAMSON CRESPO | ||||||||
| OtherFirstName: | MISTY | ||||||||
| OtherMiddleName: | LEDAWN | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 215 SHUMAN BLVD | ||||||||
| Address2: | STE 401 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605638123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303035380 | ||||||||
| FaxNumber: | 9783136824 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 VERDE VALLEY SCHOOL RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | SEDONA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863519053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282845200 | ||||||||
| FaxNumber: | 9282845201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2014 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HAD.0000284 | CO | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | HADS000922 | GA | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | HADR10832 | AZ | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.