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General NPI Number Information
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NPI Number | 1851647168
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Entity Type | Individual
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Provider Name | KYMRY HART FOWLER MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 27184 ORTEGA HWY STE 103
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2796
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Country | US
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Telephone | 949-374-4868
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Fax | 949-606-8262
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Provider Business Mailing Address
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Address Line | 127 AVENIDA SERRA APT B
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-6780
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Country | US
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Telephone | 949-374-4868
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Fax | 949-606-8262
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 17425
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP17425
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License Number State | CA
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