Provider Demographics
NPI:1891208468
Name:KULA, KATHY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:KULA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:CISLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 S GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4252
Mailing Address - Country:US
Mailing Address - Phone:630-861-4789
Mailing Address - Fax:
Practice Address - Street 1:100 S GARFIELD ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4252
Practice Address - Country:US
Practice Address - Phone:630-861-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL42963103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool