Healthcare Provider Details

I. General information

NPI: 1053801126
Provider Name (Legal Business Name): KAYLEE CALDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2547 AUDUBON CT
CAMINO CA
95709-9740
US

IV. Provider business mailing address

2547 AUDUBON CT
CAMINO CA
95709-9740
US

V. Phone/Fax

Practice location:
  • Phone: 530-303-6581
  • Fax:
Mailing address:
  • Phone: 916-296-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: