Healthcare Provider Details

I. General information

NPI: 1528476520
Provider Name (Legal Business Name): CATHERINE KUKLINSKI M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 SPRING CREEK RD
MACUNGIE PA
18062-9784
US

IV. Provider business mailing address

1832 PINE NEEDLE CV
FOGELSVILLE PA
18051-1529
US

V. Phone/Fax

Practice location:
  • Phone: 610-366-0500
  • Fax:
Mailing address:
  • Phone: 570-954-3098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL011636
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: