Provider Demographics
NPI:1568778025
Name:KUKA, CYNTHIA (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:KUKA
Suffix:
Gender:F
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 1:5729 REDDIN RD
Mailing Address - Street 2:
Mailing Address - City:RUDOLPH
Mailing Address - State:WI
Mailing Address - Zip Code:54475-9593
Mailing Address - Country:US
Mailing Address - Phone:608-498-8614
Mailing Address - Fax:
Practice Address - Street 1:8014 BETHEL RD
Practice Address - Street 2:
Practice Address - City:ARPIN
Practice Address - State:WI
Practice Address - Zip Code:54410-9558
Practice Address - Country:US
Practice Address - Phone:715-652-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI267-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42777800Medicaid