Provider Demographics
NPI:1083267454
Name:CROWTHER, KAYLAN SEON (RDN, CDE)
Entity Type:Individual
Prefix:
First Name:KAYLAN
Middle Name:SEON
Last Name:CROWTHER
Suffix:
Gender:F
Credentials:RDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11294 E HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1711
Mailing Address - Country:US
Mailing Address - Phone:608-770-3991
Mailing Address - Fax:
Practice Address - Street 1:1960 N OGDEN ST STE 550
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3676
Practice Address - Country:US
Practice Address - Phone:303-812-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1034424133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered