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General NPI Number Information
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NPI Number | 1245195643
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Entity Type | Individual
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Provider Name | KRYSTAL MARIE TREADWELL
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Gender | Female
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | PO BOX 392
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City | TRAVERSE CITY
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State | MI
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Zip | 49685-0392
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Country | US
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Telephone | 231-268-0007
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Fax | 231-525-3170
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Provider Business Mailing Address
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Address Line | 103B W CHERRY CREEK RD
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City | MIO
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State | MI
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Zip | 48647-9378
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Country | US
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Telephone | 989-390-6297
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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