Healthcare Provider Details

I. General information

NPI: 1285538272
Provider Name (Legal Business Name): KAYLEIGH FENTERMACHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 KIRKER PASS RD STE A
CLAYTON CA
94517-1084
US

IV. Provider business mailing address

15320 MARSH CREEK RD
CLAYTON CA
94517-9762
US

V. Phone/Fax

Practice location:
  • Phone: 925-567-5308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number47273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: