Provider Demographics
NPI:1861386161
Name:CRITTENDON, CRYSTAL (IBCLC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:CRITTENDON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 ANN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-3534
Mailing Address - Country:US
Mailing Address - Phone:678-593-0834
Mailing Address - Fax:
Practice Address - Street 1:7455 ANN ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-3534
Practice Address - Country:US
Practice Address - Phone:678-593-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL-317034174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN