MEDICARE: MR. MICHAEL KLUK M.B.A.,M.A., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	1779	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	957269	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1447255237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL KLUK M.B.A.,M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	4877 N TERRITORY AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-5960
Country	:	US
Telephone Number	:	520-529-0285
Fax Number	:

Provider Business Practice Location Address
First Line	:	4877 N TERRITORY AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-5960
Country	:	US
Telephone Number	:	520-529-0285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	04/23/2009

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Directions to “ MR. MICHAEL KLUK M.B.A.,M.A., CCC-SLP” Practice Location

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