Provider Demographics
NPI:1881820348
Name:KUKLA, KENNETH R (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:R
Last Name:KUKLA
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 1:638 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-1104
Mailing Address - Country:US
Mailing Address - Phone:262-723-5804
Mailing Address - Fax:262-723-5874
Practice Address - Street 1:638 N BROAD ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-1104
Practice Address - Country:US
Practice Address - Phone:262-723-5804
Practice Address - Fax:262-723-5874
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2049-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist