Provider Demographics
NPI:1972963262
Name:BYRER, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BYRER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 MISSION CENTER CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1322
Mailing Address - Country:US
Mailing Address - Phone:619-578-2232
Mailing Address - Fax:619-578-2231
Practice Address - Street 1:861 HAROLD PL
Practice Address - Street 2:SUITE 205
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4553
Practice Address - Country:US
Practice Address - Phone:619-578-2232
Practice Address - Fax:619-578-2231
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA 36642355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330965547OtherADDIE'S AUTISM FITT CLUB