Healthcare Provider Details

I. General information

NPI: 1356012215
Provider Name (Legal Business Name): KAILIE NICOLE JONES SPEECH PATH ASST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CARNEGIE AVE STE 1C
SANTA ANA CA
92705-5504
US

IV. Provider business mailing address

11037 WARNER AVE # 339
FOUNTAIN VALLEY CA
92708-4007
US

V. Phone/Fax

Practice location:
  • Phone: 800-273-4292
  • Fax: 714-596-6274
Mailing address:
  • Phone: 800-273-4292
  • Fax: 714-596-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number7278
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: