Provider Demographics
NPI:1003702085
Name:MACLEOD, KELLY CHRISTINE
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:CHRISTINE
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 RIDGEROCK
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5901
Mailing Address - Country:US
Mailing Address - Phone:949-433-5563
Mailing Address - Fax:
Practice Address - Street 1:1000 CALLE AMANECER
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6214
Practice Address - Country:US
Practice Address - Phone:949-498-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist