Most Relevant Information
Provider Data
| NPI Number: | 1003405341 |
| Provider Name: | CRYSTAL LYNN BLAKKAN |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 106370 |
Most Important Dates
| Enumeration Date: | 01/12/2021 |
| Last Updated: | 07/03/2023 |
Provider Practice Location
1738 N WATERMAN AVE
SAN BERNARDINO
CA
924045131
Practice Location Phone/Fax
| Phone: | 9096933302 |
| Fax: |
Provider Mailing Location
1738 N WATERMAN AVE
SAN BERNARDINO
CA
924045131
Provider Mailing Phone/Fax
| Phone: | 9096933302 |
| Fax: |