MEDICARE: KFI SPEECH THERAPY, PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1841756582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KFI SPEECH THERAPY, PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	127 AVENIDA SERRA APT B
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-6780
Country	:	US
Telephone Number	:	949-374-4868
Fax Number	:	888-420-6257

Provider Business Practice Location Address
First Line	:	27184 ORTEGA HWY STE 103
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-2796
Country	:	US
Telephone Number	:	949-374-4868
Fax Number	:	949-606-8262

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. KYMRY HART FOWLER
Credential	:	MS-CCC
Telephone Number	:	949-374-4868

Provider Enumeration Date	:	02/19/2019
Last Update Date	:	06/12/2024

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Directions to “KFI SPEECH THERAPY, PROFESSIONAL CORPORATION ” Practice Location

Language	Start Address	Practice Location

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