Healthcare Provider Details

I. General information

NPI: 1083267454
Provider Name (Legal Business Name): KAYLAN SEON CROWTHER RDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 N OGDEN ST STE 550
DENVER CO
80218-3676
US

IV. Provider business mailing address

11294 E HARVARD DR
AURORA CO
80014-1711
US

V. Phone/Fax

Practice location:
  • Phone: 303-812-6850
  • Fax:
Mailing address:
  • Phone: 608-770-3991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1034424
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: