Healthcare Provider Details

I. General information

NPI: 1194029876
Provider Name (Legal Business Name): KRYSTAL MARIE OSWALD BCBA, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTAL MARIE RHINES

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 MOUNT PLEASANT LN
BELLEVILLE IL
62223-3944
US

IV. Provider business mailing address

5801 MOUNT PLEASANT LN
BELLEVILLE IL
62223-3944
US

V. Phone/Fax

Practice location:
  • Phone: 618-489-5102
  • Fax:
Mailing address:
  • Phone: 618-489-5102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.114174
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152.001327
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number023005308
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-26500
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: