Healthcare Provider Details

I. General information

NPI: 1194633594
Provider Name (Legal Business Name): KAYTLYNN CROWE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 3RD AVE
ROCK ISLAND IL
61201-8840
US

IV. Provider business mailing address

2200 3RD AVE
ROCK ISLAND IL
61201-8840
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-7500
  • Fax: 309-779-7505
Mailing address:
  • Phone: 309-779-7500
  • Fax: 309-779-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number149031747
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number140518
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: