Healthcare Provider Details

I. General information

NPI: 1568397438
Provider Name (Legal Business Name): KAITLYN LEE PERSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4281 KATELLA AVE STE 101
LOS ALAMITOS CA
90720-3584
US

IV. Provider business mailing address

15845 LA PORTE CT
MORGAN HILL CA
95037-5671
US

V. Phone/Fax

Practice location:
  • Phone: 424-225-1481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: