Healthcare Provider Details

I. General information

NPI: 1558094250
Provider Name (Legal Business Name): KAILEY KELLEY SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7122 MAPLE ST
WESTMINSTER CA
92683-5045
US

IV. Provider business mailing address

14121 CEDARWOOD ST
WESTMINSTER CA
92683-4499
US

V. Phone/Fax

Practice location:
  • Phone: 714-895-3765
  • Fax:
Mailing address:
  • Phone: 714-894-7311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number28774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: