Basic Information
| Provider Information | |||||||||
| NPI: | 1821138322 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROWLEY | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | MOYNAHAN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS CCC SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOYNAHAN | ||||||||
| OtherFirstName: | KATHLEEN | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MS CCC SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4102 EAST SAINT JOSEPH WAY | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850181155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029529235 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | SEQUAYA ELEMENTARY SCHOOL | ||||||||
| Address2: | 1108 N 64TH STREET | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804843200 | ||||||||
| FaxNumber: | 4804843201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP 2041 | AZ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 085654 | 05 | AZ | MEDICAID |