Healthcare Provider Details

I. General information

NPI: 1811828155
Provider Name (Legal Business Name): KAYLA SEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W LUGONIA AVE
REDLANDS CA
92374-2234
US

IV. Provider business mailing address

739 GHENT ST
LA VERNE CA
91750-3829
US

V. Phone/Fax

Practice location:
  • Phone: 909-307-2460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number20897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: