Provider Demographics
NPI:1235985904
Name:CRAFTON, KAYLEE LYNN (ASW)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:LYNN
Last Name:CRAFTON
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 BREA BLVD APT 23
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2767
Mailing Address - Country:US
Mailing Address - Phone:734-837-5861
Mailing Address - Fax:
Practice Address - Street 1:456 OLD NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4211
Practice Address - Country:US
Practice Address - Phone:949-781-9025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118749104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker