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NPI Code Detail

MEDICARE: KAYLEIGH CROCKER SWT

MEDICARE: KAYLEIGH CROCKER SWT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2390200000XStudent in an Organized Health Care Education/Training ProgramS.2504385-TRNEOH

General Provider Information

NPI Number : 1184379554
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLEIGH CROCKER SWT
Provider Business Mailing Address
First Line : 2100 N RIDGE RD
Second Line :
City : ELYRIA
State : OH
Zip : 44035-1241
Country : US
Telephone Number : 440-324-1300
Fax Number : 440-277-0409
Provider Business Practice Location Address
First Line : 2100 N RIDGE RD
Second Line :
City : ELYRIA
State : OH
Zip : 44035-1241
Country : US
Telephone Number : 440-324-1300
Fax Number : 440-277-0409
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2022
Last Update Date : 01/15/2026

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Directions to “ KAYLEIGH CROCKER SWT” Practice Location

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