Healthcare Provider Details

I. General information

NPI: 1437096187
Provider Name (Legal Business Name): KIMBERLY EDWARDS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 CONWAY DR
ESCONDIDO CA
92027-1347
US

IV. Provider business mailing address

1954 COURAGE ST
VISTA CA
92081-7021
US

V. Phone/Fax

Practice location:
  • Phone: 760-432-2435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number26456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: