MEDICARE: KAITLYN ELIZABETH CRAWFORD

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	235Z00000X	Speech-Language Pathologist	LL60965361	WA
2	235Z00000X	Speech-Language Pathologist	4381	KS

General Provider Information

NPI Number	:	1619520442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN ELIZABETH CRAWFORD

Provider Business Mailing Address
First Line	:	1827 GLENDALE RD
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-6678
Country	:	US
Telephone Number	:	785-643-2272
Fax Number	:

Provider Business Practice Location Address
First Line	:	1827 GLENDALE RD
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-6678
Country	:	US
Telephone Number	:	785-643-2272
Fax Number	:

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

Provider Enumeration Date	:	07/21/2019
Last Update Date	:	07/21/2019

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Directions to “ KAITLYN ELIZABETH CRAWFORD ” Practice Location

Language	Start Address	Practice Location

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