Provider Demographics
NPI:1528372554
Name:KUNKEL, SHIRLEY DIANNE (MSCCC)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:DIANNE
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:MSCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9649 GALATEA LANE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026
Mailing Address - Country:US
Mailing Address - Phone:760-751-3430
Mailing Address - Fax:760-751-3431
Practice Address - Street 1:9649 GALATEA LANE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026
Practice Address - Country:US
Practice Address - Phone:760-751-3430
Practice Address - Fax:760-751-3431
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist