Healthcare Provider Details

I. General information

NPI: 1821935552
Provider Name (Legal Business Name): KAHLEENA CHRISTINE FULMER CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA FULMER CCC-SLP

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

1820 OAK HILL DR
ESCONDIDO CA
92027-3731
US

IV. Provider business mailing address

4120 VIA CANDIDIZ UNIT 127
SAN DIEGO CA
92130-6106
US

V. Phone/Fax

Practice location:
  • Phone: 760-432-2483
  • Fax:
Mailing address:
  • Phone: 408-420-9354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number40581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: