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General NPI Number Information
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NPI Number | 1205596020
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Entity Type | Individual
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Provider Name | KRYSTAL RANSOM
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Gender | Female
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Dates
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Enumeration Date | 12/20/2021
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 7900 CASS AVE
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City | DARIEN
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State | IL
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Zip | 60561-5073
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Country | US
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Telephone | 630-884-8643
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Fax |
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Provider Business Mailing Address
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Address Line | 3388 83RD ST
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City | WOODRIDGE
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State | IL
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Zip | 60517-3633
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Country | US
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Telephone | 773-406-3132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.104980
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License Number State | IL
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