Provider Demographics
NPI:1053106625
Name:WILLIAMS, KRYSTAWNA MELLINA
Entity type:Individual
Prefix:
First Name:KRYSTAWNA
Middle Name:MELLINA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISSY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2585 NW SPRUCE CONE LN
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2064
Mailing Address - Country:US
Mailing Address - Phone:541-815-8812
Mailing Address - Fax:
Practice Address - Street 1:1769 SW PARKWAY DR
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2550
Practice Address - Country:US
Practice Address - Phone:541-316-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst