Provider Demographics
NPI:1447038963
Name:CRANDALL, KATLYN RENEE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:RENEE
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2858 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1118
Mailing Address - Country:US
Mailing Address - Phone:727-259-5662
Mailing Address - Fax:
Practice Address - Street 1:1700 N MCMULLEN BOOTH RD STE D4
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-2129
Practice Address - Country:US
Practice Address - Phone:813-435-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA22973235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist