Provider Demographics
NPI:1932532983
Name:CRENSHAW, KAELYN (MT, DOULA, LE)
Entity Type:Individual
Prefix:
First Name:KAELYN
Middle Name:
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:MT, DOULA, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 30TH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3359
Mailing Address - Country:US
Mailing Address - Phone:916-226-0527
Mailing Address - Fax:
Practice Address - Street 1:225 30TH ST STE 303
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3359
Practice Address - Country:US
Practice Address - Phone:916-226-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16687172V00000X, 225700000X
174H00000X, 374J00000X
CA174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula