Kimberly Michelle Chagolla, SLPA, B.A.

Primary specialty

Speech-Language AssistantTaxonomy code 2355S0801X

License

5179 Issued in CA

Practice address

26623 Placentia Ave
Perris, CA 92571-7302

Phone

(323) 861-9824

NPI assigned

Mar 25, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kimberly Michelle Chagolla Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585094400000",
    "number": "1396372769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26623 PLACENTIA AVE",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925717302",
            "telephone_number": "323-861-9824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26623 PLACENTIA AVE",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925717302",
            "telephone_number": "323-861-9824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAGOLLA",
        "first_name": "KIMBERLY",
        "middle_name": "MICHELLE",
        "credential": "SLPA, B.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-25",
        "last_updated": "2020-03-25",
        "certification_date": "2020-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "CA",
            "license": "5179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "CHAGOLLA",
            "middle_name": "MICHELLE",
            "credential": "SLPA, B.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Assistant in Perris, CA
• Providers in Perris, CA by specialty
• Speech-Language Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.