Provider Demographics
NPI:1316760408
Name:KULP, KATHLEEN GRACE (CLS)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:GRACE
Last Name:KULP
Suffix:
Gender:F
Credentials:CLS
Other - Prefix:MS
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:KULP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLS
Mailing Address - Street 1:5912 HANNA RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6717
Mailing Address - Country:US
Mailing Address - Phone:410-259-1707
Mailing Address - Fax:
Practice Address - Street 1:1332 LONDONTOWN BLVD STE 108D
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-6587
Practice Address - Country:US
Practice Address - Phone:443-454-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist