Healthcare Provider Details

I. General information

NPI: 1427478460
Provider Name (Legal Business Name): MRS. CRYSTAL ZAVICAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S WINTER ST SUITE 1022
ADRIAN MI
49221-3876
US

IV. Provider business mailing address

1275 MILAN OAKVILLE RD
MILAN MI
48160-9766
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-8905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: