Provider Demographics
NPI:1558094250
Name:KELLEY, KAILEY (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14121 CEDARWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4499
Mailing Address - Country:US
Mailing Address - Phone:714-894-7311
Mailing Address - Fax:
Practice Address - Street 1:7122 MAPLE ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5045
Practice Address - Country:US
Practice Address - Phone:714-895-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist