Healthcare Provider Details

I. General information

NPI: 1881232619
Provider Name (Legal Business Name): KAILEY MARIE SPASOVSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W ELDER ST
FALLBROOK CA
92028-2870
US

IV. Provider business mailing address

321 IOWA ST
FALLBROOK CA
92028-2108
US

V. Phone/Fax

Practice location:
  • Phone: 760-731-4132
  • Fax:
Mailing address:
  • Phone: 760-731-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP38690
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: