Provider Demographics
NPI:1558619726
Name:KULACH, ALEXANDRA (MSP, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:KULACH
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 PAN AMERICAN FWY NE STE D
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4793
Mailing Address - Country:US
Mailing Address - Phone:505-888-4469
Mailing Address - Fax:
Practice Address - Street 1:3530 PAN AMERICAN FWY NE STE D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4793
Practice Address - Country:US
Practice Address - Phone:505-888-4469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist