MEDICARE: MRS. PHYLLIS STELL CROWLEY MS, RD, IBCLC

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	133V00000X	Registered Dietitian	375264-4901	UT
2	133V00000X	Registered Dietitian	0000000124	TN

General Provider Information

NPI Number	:	1952517286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PHYLLIS STELL CROWLEY MS, RD, IBCLC

Provider Business Mailing Address
First Line	:	7907 HONEYWOOD COVE DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5916
Country	:	US
Telephone Number	:	801-944-0956
Fax Number	:

Provider Business Practice Location Address
First Line	:	7907 HONEYWOOD COVE DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5916
Country	:	US
Telephone Number	:	801-944-0956
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	05/24/2026

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