Provider Demographics
NPI:1508199050
Name:JAGARLAMUDI, KIRAN (MASTERS)
Entity Type:Individual
Prefix:MS
First Name:KIRAN
Middle Name:
Last Name:JAGARLAMUDI
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16616 CENTRAL GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-1672
Mailing Address - Country:US
Mailing Address - Phone:412-390-6446
Mailing Address - Fax:
Practice Address - Street 1:16616 CENTRAL GARDEN LN
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-1672
Practice Address - Country:US
Practice Address - Phone:412-390-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007769235Z00000X
TX118596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist