Healthcare Provider Details

I. General information

NPI: 1841756582
Provider Name (Legal Business Name): KFI SPEECH THERAPY, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 06/12/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27184 ORTEGA HWY STE 103
SAN JUAN CAPISTRANO CA
92675-2796
US

IV. Provider business mailing address

127 AVENIDA SERRA APT B
SAN CLEMENTE CA
92672-6780
US

V. Phone/Fax

Practice location:
  • Phone: 949-374-4868
  • Fax: 949-606-8262
Mailing address:
  • Phone: 949-374-4868
  • Fax: 888-420-6257

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: MS. KYMRY HART FOWLER
Title or Position: PRESIDENT
Credential: MS-CCC
Phone: 949-374-4868