Healthcare Provider Details

I. General information

NPI: 1154277721
Provider Name (Legal Business Name): KACI CALLAWAY CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 W 5TH ST OFC 2876B
LOS ANGELES CA
90071-2005
US

IV. Provider business mailing address

440 N BARRANCA AVE # 9898
COVINA CA
91723-1722
US

V. Phone/Fax

Practice location:
  • Phone: 512-377-6318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: