Healthcare Provider Details

I. General information

NPI: 1770418279
Provider Name (Legal Business Name): KATHRYN CROSLOW RN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 ILLINOIS AVE
ST CHARLES IL
60174-2152
US

IV. Provider business mailing address

511 ILLINOIS AVE
ST CHARLES IL
60174-2152
US

V. Phone/Fax

Practice location:
  • Phone: 815-762-3732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberALPP-338454
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number041.389655
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number041.389655
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: