Provider Demographics
NPI:1144519257
Name:HEDLIN, CHRYSTAL ANN (LCSW)
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:ANN
Last Name:HEDLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648-0790
Mailing Address - Country:US
Mailing Address - Phone:559-646-6618
Mailing Address - Fax:559-876-6705
Practice Address - Street 1:650 S ZEDIKER AVE
Practice Address - Street 2:
Practice Address - City:PARLIER
Practice Address - State:CA
Practice Address - Zip Code:93648-2666
Practice Address - Country:US
Practice Address - Phone:559-646-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTLMSW-30972104100000X
CA624181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA62418OtherSTATE OF CA LCSW