=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841497161
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAILI CHAPMAN CFY-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4551 STEELE ST
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94619-2743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-879-1760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 523 BUENA VISTA AVE APT. 115
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94501-2075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-710-8755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | RPE 4672
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------