Healthcare Provider Details

I. General information

NPI: 1447829502
Provider Name (Legal Business Name): CRYSTAL MATHIESON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 42ND AVE SW APT 320
SEATTLE WA
98116-4620
US

IV. Provider business mailing address

4715 42ND AVE SW APT 320
SEATTLE WA
98116-4620
US

V. Phone/Fax

Practice location:
  • Phone: 253-881-9854
  • Fax:
Mailing address:
  • Phone: 253-881-9854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: