Healthcare Provider Details

I. General information

NPI: 1134252943
Provider Name (Legal Business Name): LAURA KELLOGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43414 BUSINESS PARK DR
TEMECULA CA
92590-5526
US

IV. Provider business mailing address

43414 BUSINESS PARK DR
TEMECULA CA
92590-5526
US

V. Phone/Fax

Practice location:
  • Phone: 866-354-8302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-12775
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number250041008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: