Provider Demographics
NPI:1215794144
Name:LAWSON, CRYSTAL (LCSW)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:LAWSON
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 1:6416 PALO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8174
Mailing Address - Country:US
Mailing Address - Phone:815-315-2364
Mailing Address - Fax:
Practice Address - Street 1:555 S PERRYVILLE RD STE 118
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2522
Practice Address - Country:US
Practice Address - Phone:608-313-5442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0267081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical