Healthcare Provider Details

I. General information

NPI: 1689591372
Provider Name (Legal Business Name): KATHRYN BLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 UNIVERSITY AVE
LA MESA CA
91942-0500
US

IV. Provider business mailing address

4795 TALMADGE CANYON ROW
SAN DIEGO CA
92115-1953
US

V. Phone/Fax

Practice location:
  • Phone: 619-333-0434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: