Provider Demographics
NPI:1982329504
Name:SNOWBALL, CRYSTAL DAWN (AA)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:DAWN
Last Name:SNOWBALL
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S. BLUFF STREET
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:NE
Mailing Address - Zip Code:68071
Mailing Address - Country:US
Mailing Address - Phone:402-878-3660
Mailing Address - Fax:402-878-2027
Practice Address - Street 1:206 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:NE
Practice Address - Zip Code:68071-6807
Practice Address - Country:US
Practice Address - Phone:402-878-2231
Practice Address - Fax:402-878-2204
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1089101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)