MEDICARE: KAYLEE LYNN CRAFTON ASW

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
1	104100000X	Social Worker	118749	CA

General Provider Information

NPI Number	:	1235985904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEE LYNN CRAFTON ASW

Provider Business Mailing Address
First Line	:	2700 BREA BLVD APT 23
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-2767
Country	:	US
Telephone Number	:	734-837-5861
Fax Number	:

Provider Business Practice Location Address
First Line	:	456 OLD NEWPORT BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4211
Country	:	US
Telephone Number	:	949-781-9025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2024
Last Update Date	:	04/24/2024

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