Active NPI
Kylie Puckett, CCC-SLP
- Speech-Language Pathologist
- Los Angeles, CA
National Provider Identifier
1447920947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 20067
- Practice address
- 4454 S Slauson Ave
Los Angeles, CA 90230-5144 - Phone
- (661) 993-8037
- NPI assigned
- Sep 16, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 20067 | CA | Primary |
Addresses
Primary practice location
4454 S Slauson Ave
Los Angeles, CA 90230-5144
Mailing address
4454 S Slauson Ave
Los Angeles, CA 90230-5144
Phone (661) 993-8037
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20067 | CA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pom Pom Speech & Language Therapy, Inc. | Speech-Language Pathologist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Speech-Language Pathologist
- Big Bear City, CA
- NPI 1912747890
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631750400000",
"number": "1447920947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4454 S SLAUSON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "902305144",
"telephone_number": "661-993-8037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4454 S SLAUSON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "902305144",
"telephone_number": "661-993-8037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "KYLIE",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-16",
"last_updated": "2021-09-16",
"certification_date": "2021-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "20067",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.