Active NPI
Kaitlynn Rose Chavez, MS, CCC-SLP
- Speech-Language Pathologist
- Antioch, CA
National Provider Identifier
1447986336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 23165
- Practice address
- 3700 Delta Fair Blvd Ste 205
Antioch, CA 94509-4074 - Phone
- (650) 648-3095
- NPI assigned
- Jul 25, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | 23165 | CA | Primary |
Addresses
Primary practice location
3700 Delta Fair Blvd Ste 205
Antioch, CA 94509-4074
Mailing address
10388 Avenal St
Oak Hills, CA 92344-0384
Phone (760) 553-3830
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23165 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658707200000",
"number": "1447986336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10388 AVENAL ST",
"city": "OAK HILLS",
"state": "CA",
"postal_code": "923440384",
"telephone_number": "760-553-3830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3700 DELTA FAIR BLVD STE 205",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945094074",
"telephone_number": "650-648-3095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAVEZ",
"first_name": "KAITLYNN",
"middle_name": "ROSE",
"name_prefix": "Mrs.",
"credential": "MS, CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-07-25",
"last_updated": "2022-07-25",
"certification_date": "2022-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "23165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.