Provider Demographics
NPI:1114396090
Name:KULA, KRISTINE MARIE (SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:MARIE
Last Name:KULA
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-2909
Mailing Address - Country:US
Mailing Address - Phone:402-457-5905
Mailing Address - Fax:402-457-6525
Practice Address - Street 1:3905 N 52ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2909
Practice Address - Country:US
Practice Address - Phone:402-457-5905
Practice Address - Fax:402-457-6525
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist