Provider Demographics
NPI:1245464122
Name:CRAWLEY, KATIE T (DO)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:T
Last Name:CRAWLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:T
Other - Last Name:GUALANDRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-1747
Mailing Address - Country:US
Mailing Address - Phone:309-688-7010
Mailing Address - Fax:309-688-7044
Practice Address - Street 1:2901 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-1747
Practice Address - Country:US
Practice Address - Phone:309-688-7010
Practice Address - Fax:309-688-7044
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.132790207V00000X
IL036132790207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology