Semetrah Alima Kincannon, M.S. CCC SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP28180 Issued in CA

Practice address

14369 Park Ave Ste 201a
Victorville, CA 92392-2300

Phone

(760) 278-1484

Fax

(855) 719-2558

NPI assigned

Nov 24, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Momentum Speech Therapy Inc

  • Speech-Language Pathologist
  • Victorville, CA
  • NPI 1134701048
  Medicare reassignment NPD Authorized official
• High Desert Speech

  • Audiology Assistant
  • Hesperia, CA
  • NPI 1780085316
  NPD (past)

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

{
    "created_epoch": "1543017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727481600000",
    "number": "1518436278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12722 SILVER SPUR WAY",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923927437",
            "telephone_number": "760-694-3240",
            "fax_number": "855-719-2558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14369 PARK AVE STE 201A",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923922300",
            "telephone_number": "760-278-1484",
            "fax_number": "855-719-2558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINCANNON",
        "first_name": "SEMETRAH",
        "middle_name": "ALIMA",
        "credential": "M.S. CCC SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-24",
        "last_updated": "2024-09-28",
        "certification_date": "2024-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP28180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sang Jo Kim, L.AC.
• Taejune Kim
• Yoonah Kim
• Tamara Lee Kimball
• Kimberly Moret Licensed Clinical Social Worker, PC
• Sarah Renee Kindred, AMFT, APCC
• Pamela King-Terry
• Amber King, LCSW
• Beverly A King
• Daishya Analyce King

• Speech-Language Pathologist in Victorville, CA
• Providers in Victorville, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.