Provider Demographics
NPI:1154146736
Name:KUNKEL, VILA NOEMI
Entity type:Individual
Prefix:
First Name:VILA
Middle Name:NOEMI
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 E OLD LAKE LN
Mailing Address - Street 2:
Mailing Address - City:FRUIT HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84037-3230
Mailing Address - Country:US
Mailing Address - Phone:801-663-6790
Mailing Address - Fax:
Practice Address - Street 1:1624 E OLD LAKE LN
Practice Address - Street 2:
Practice Address - City:FRUIT HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84037-3230
Practice Address - Country:US
Practice Address - Phone:801-663-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician