Healthcare Provider Details

I. General information

NPI: 1619261096
Provider Name (Legal Business Name): JAMI KUKLA M.S., CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 WASHINGTON AVE
TYRONE PA
16686-1426
US

IV. Provider business mailing address

1623 N 11TH AVE
ALTOONA PA
16601-6330
US

V. Phone/Fax

Practice location:
  • Phone: 814-684-0320
  • Fax:
Mailing address:
  • Phone: 814-941-3805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL009388
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: