Provider Demographics
NPI:1710120639
Name:KULBETH-ENGEL, BUFFY LORRAINE (MS CCC-SLP/L)
Entity Type:Individual
Prefix:MS
First Name:BUFFY
Middle Name:LORRAINE
Last Name:KULBETH-ENGEL
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 W 64TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-5037
Mailing Address - Country:US
Mailing Address - Phone:312-339-2125
Mailing Address - Fax:815-301-5555
Practice Address - Street 1:6444 W 65TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-5102
Practice Address - Country:US
Practice Address - Phone:312-339-2125
Practice Address - Fax:815-301-5555
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist