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General NPI Number Information
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NPI Number | 1235985904
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Entity Type | Individual
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Provider Name | KAYLEE LYNN CRAFTON ASW
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Gender | Female
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Dates
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Enumeration Date | 04/24/2024
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 456 OLD NEWPORT BLVD
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4211
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Country | US
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Telephone | 949-781-9025
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 BREA BLVD APT 23
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City | FULLERTON
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State | CA
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Zip | 92835-2767
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Country | US
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Telephone | 734-837-5861
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 118749
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License Number State | CA
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