Individual
KENYATTA CRAWFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3149 W 15TH ST APT 2, CHICAGO, IL 60623-2200
(312) 316-0479
Mailing address
3149 W 15TH ST APT 2, CHICAGO, IL 60623-2200
(312) 316-0479
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
08/12/2021
Last updated
08/13/2021
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