Provider Demographics
NPI:1528292703
Name:REDDERSEN-PICARO, CHRYSTAL
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:
Last Name:REDDERSEN-PICARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MOUNTAINVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-7702
Mailing Address - Country:US
Mailing Address - Phone:908-868-1714
Mailing Address - Fax:908-647-0502
Practice Address - Street 1:24 MOUNTAINVIEW RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-7702
Practice Address - Country:US
Practice Address - Phone:908-868-1714
Practice Address - Fax:908-647-0502
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-1628235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist