Provider Demographics
NPI:1457497489
Name:CRANE, KATHLEEN LOUISE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:CRANE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 W WADE LN
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4886
Mailing Address - Country:US
Mailing Address - Phone:928-472-5800
Mailing Address - Fax:928-472-2008
Practice Address - Street 1:514 W WADE LN
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4886
Practice Address - Country:US
Practice Address - Phone:928-472-5800
Practice Address - Fax:928-472-2008
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL4005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ831116Medicaid