Provider Demographics
NPI:1164905444
Name:LASHLEY, KAITLIN HOPE
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:HOPE
Last Name:LASHLEY
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 1:5717 DEL CERRO BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4513
Mailing Address - Country:US
Mailing Address - Phone:479-739-4840
Mailing Address - Fax:
Practice Address - Street 1:3291 BUCKMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:PINE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91962-4003
Practice Address - Country:US
Practice Address - Phone:619-473-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5023235Z00000X
WA60884892235Z00000X
CA28473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist