Healthcare Provider Details

I. General information

NPI: 1912816505
Provider Name (Legal Business Name): KL SLP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12061 BRIGHTON RIV UNIT 50
FOUNTAIN VALLEY CA
92708-1351
US

IV. Provider business mailing address

19744 BEACH BLVD UNIT 641
HUNTINGTON BEACH CA
92648-2988
US

V. Phone/Fax

Practice location:
  • Phone: 714-263-6520
  • Fax:
Mailing address:
  • Phone: 714-263-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KATELYN LUDDINE
Title or Position: MANAGER
Credential: MS, CCC-SLP
Phone: 714-263-6520