Provider Demographics
NPI:1821138322
Name:CROWLEY, KATHLEEN MOYNAHAN (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MOYNAHAN
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:C
Other - Last Name:MOYNAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:4102 EAST SAINT JOSEPH WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-1155
Mailing Address - Country:US
Mailing Address - Phone:602-952-9235
Mailing Address - Fax:
Practice Address - Street 1:SEQUAYA ELEMENTARY SCHOOL
Practice Address - Street 2:1108 N 64TH STREET
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:480-484-3200
Practice Address - Fax:480-484-3201
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP 2041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ085654Medicaid