MEDICARE: MS. KYMRY HART FOWLER MS, 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	17425	AR
2	235Z00000X	Speech-Language Pathologist	SP17425	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SP17425	OTHER	CA	CALIFORNIA SPEECH LANGUAGE PATHOLOGIST LICENSE

General Provider Information

NPI Number	:	1851647168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KYMRY HART FOWLER MS, CCC-SLP

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	:	949-606-8262

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	06/12/2024

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Directions to “ MS. KYMRY HART FOWLER MS, CCC-SLP” Practice Location

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