Healthcare Provider Details

I. General information

NPI: 1912839796
Provider Name (Legal Business Name): KIMBERLY CROUNSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8036 OCEAN VIEW AVE
WHITTIER CA
90602-2756
US

IV. Provider business mailing address

14833 GANDESA RD
LA MIRADA CA
90638-4421
US

V. Phone/Fax

Practice location:
  • Phone: 714-588-0618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: