Provider Demographics
NPI:1497525166
Name:WINSLOW, KRYSTAL (ASW)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:WINSLOW
Suffix:
Gender:F
Credentials:ASW
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 411
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94537-0411
Mailing Address - Country:US
Mailing Address - Phone:510-468-3770
Mailing Address - Fax:
Practice Address - Street 1:950 S BASCOM AVE STE 1014
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3537
Practice Address - Country:US
Practice Address - Phone:510-402-5302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1195631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical