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General NPI Number Information
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NPI Number | 1619261096
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Entity Type | Individual
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Provider Name | JAMI KUKLA M.S., CCC-SLP/L
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Gender | Female
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 951 WASHINGTON AVE
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City | TYRONE
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State | PA
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Zip | 16686-1426
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Country | US
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Telephone | 814-684-0320
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Fax |
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Provider Business Mailing Address
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Address Line | 1623 N 11TH AVE
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City | ALTOONA
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State | PA
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Zip | 16601-6330
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Country | US
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Telephone | 814-941-3805
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SL009388
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License Number State | PA
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