Kaylie Marlene Gustafson, MA CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

26817 Issued in CA

Practice address

33985 Manta CT
Dana Point, CA 92629-4507

Phone

(949) 336-2569

NPI assigned

Feb 14, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1518566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1679073969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33985 MANTA CT",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926294507",
            "telephone_number": "949-336-2569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33985 MANTA CT",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926294507",
            "telephone_number": "949-336-2569"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4695 MacArthur Ct Ste 1100",
            "address_purpose": "LOCATION",
            "city": "Newport Beach",
            "state": "CA",
            "postal_code": "926601866",
            "country_code": "US",
            "telephone_number": "949-478-4484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "KAYLIE",
        "middle_name": "MARLENE",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-14",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "26817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarv Mittar Grover, M.D.
• Michelle Giselle Guerrero
• Jessica Guilfoyle, MFT
• Helmy M Guirgis, M.D.
• Nancy Guirgis
• Amber Guzman
• Nebiat Habte, LMFT
• Terrill K. Haws, D.O.
• Luis Andres Hernandez
• Edythe M Heus, D.C.

• Speech-Language Pathologist in Dana Point, CA
• Providers in Dana Point, 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 Feb 26, 2024; 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.