Healthcare Provider Details

I. General information

NPI: 1194442905
Provider Name (Legal Business Name): KAYTEE CRAWFORD CST CPE CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 DAYTON AVE STE 111
SAINT PAUL MN
55104-6276
US

IV. Provider business mailing address

1619 DAYTON AVE STE 111
SAINT PAUL MN
55104-6276
US

V. Phone/Fax

Practice location:
  • Phone: 952-237-6478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: