Healthcare Provider Details

I. General information

NPI: 1912864745
Provider Name (Legal Business Name): JENELLE KAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10850 COLLETT AVE
RIVERSIDE CA
92505-2926
US

IV. Provider business mailing address

4291 ELMWOOD CT
RIVERSIDE CA
92506-1136
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-1645
  • Fax:
Mailing address:
  • Phone: 951-217-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP25447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: