Healthcare Provider Details

I. General information

NPI: 1295661007
Provider Name (Legal Business Name): KYLE PATRICK CROWLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 STOCKTON BLVD
SACRAMENTO CA
95817-2215
US

IV. Provider business mailing address

1516 33RD ST
SACRAMENTO CA
95816-6507
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-2191
  • Fax:
Mailing address:
  • Phone: 530-526-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP24490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: