Healthcare Provider Details

I. General information

NPI: 1699534859
Provider Name (Legal Business Name): KATELYN DALY SPANGENBERG M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E ORANGETHORPE AVE
PLACENTIA CA
92870-5302
US

IV. Provider business mailing address

6035 TOULAN WAY
YORBA LINDA CA
92887-6226
US

V. Phone/Fax

Practice location:
  • Phone: 714-986-7000
  • Fax:
Mailing address:
  • Phone: 714-520-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP36913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: