Healthcare Provider Details

I. General information

NPI: 1962367482
Provider Name (Legal Business Name): MR. LOGAN CROWLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34981 WILLOW SPRINGS DR
YUCAIPA CA
92399-5932
US

IV. Provider business mailing address

34981 WILLOW SPRINGS DR
YUCAIPA CA
92399-5932
US

V. Phone/Fax

Practice location:
  • Phone: 310-384-2280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: