Healthcare Provider Details

I. General information

NPI: 1528021367
Provider Name (Legal Business Name): RUTHANN A KUKLA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SPANGENBURG AVE
EAST STROUDSBURG PA
18301-2749
US

IV. Provider business mailing address

75 SPANGENBURG AVE
EAST STROUDSBURG PA
18301-2749
US

V. Phone/Fax

Practice location:
  • Phone: 570-236-6615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW124611
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: