Provider Demographics
NPI:1467079616
Name:KULDANEK, MICHAEL E (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:KULDANEK
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35751 GATEWAY DR UNIT L1236
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6047
Mailing Address - Country:US
Mailing Address - Phone:218-464-3789
Mailing Address - Fax:
Practice Address - Street 1:35751 GATEWAY DR UNIT L1236
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6047
Practice Address - Country:US
Practice Address - Phone:218-464-3789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29369235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist