Provider Demographics
NPI:1861173916
Name:KONEN, CRYSTAL DAWN
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DAWN
Last Name:KONEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRYSLA
Other - Middle Name:DAWN
Other - Last Name:BOMMELYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8851 BRODERICK BLVD APT 114
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-5174
Mailing Address - Country:US
Mailing Address - Phone:651-270-3956
Mailing Address - Fax:
Practice Address - Street 1:731 BIELENBERG DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1700
Practice Address - Country:US
Practice Address - Phone:612-445-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician