Provider Demographics
NPI:1255478301
Name:KULKA, TAMI JOAN
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:JOAN
Last Name:KULKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10340 S TYPHOON AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-5700
Mailing Address - Country:US
Mailing Address - Phone:928-304-5179
Mailing Address - Fax:928-341-6099
Practice Address - Street 1:343 N. CARLISLE AVE.
Practice Address - Street 2:
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350
Practice Address - Country:US
Practice Address - Phone:928-341-6041
Practice Address - Fax:928-341-6099
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ931958OtherAHCCCS PROVIDER NUMBER