Healthcare Provider Details

I. General information

NPI: 1194640250
Provider Name (Legal Business Name): KATHERINE GRACE CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 CAMPBELL AVE
RIVERSIDE CA
92505-2440
US

IV. Provider business mailing address

9 KPC PKWY
CORONA CA
92879-7102
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-1665
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: