Provider Demographics
NPI:1689152324
Name:DE FALKENBERG, KAYLEE ELIZABETH (BS)
Entity Type:Individual
Prefix:MISS
First Name:KAYLEE
Middle Name:ELIZABETH
Last Name:DE FALKENBERG
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3578 MUSTANG DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-9198
Mailing Address - Country:US
Mailing Address - Phone:909-643-6709
Mailing Address - Fax:
Practice Address - Street 1:6848 MAGNOLIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2898
Practice Address - Country:US
Practice Address - Phone:951-779-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49722355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant