Healthcare Provider Details

I. General information

NPI: 1730391848
Provider Name (Legal Business Name): KATHRYN M KUNKEL M.S., CCC-SLP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19270 252ND AVE
BETTENDORF IA
52722-7350
US

IV. Provider business mailing address

19270 252ND AVE
BETTENDORF IA
52722-7350
US

V. Phone/Fax

Practice location:
  • Phone: 773-677-4925
  • Fax:
Mailing address:
  • Phone: 773-677-4925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-07-3581
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: