Provider Demographics
NPI:1750610234
Name:KULP, JESSICA LYNN (CCC-SLP-L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:KULP
Suffix:
Gender:F
Credentials:CCC-SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 SAINT PETERS RD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-7166
Mailing Address - Country:US
Mailing Address - Phone:814-404-2467
Mailing Address - Fax:
Practice Address - Street 1:1629 SAINT PETERS RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-7166
Practice Address - Country:US
Practice Address - Phone:814-404-2467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008673235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist