MEDICARE: KAILEY CLAIRE DUNLAP M.A., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	32655	CA

General Provider Information

NPI Number	:	1619722428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILEY CLAIRE DUNLAP M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	3051 BENVENUE AVE UNIT B
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3051 BENVENUE AVE UNIT B
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2509
Country	:	US
Telephone Number	:	925-683-1474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	04/23/2024

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