Provider Demographics
NPI:1043703986
Name:KUNKEL, DESTINY MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:MARIE
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:MARIE
Other - Last Name:ROEHRIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4300 W WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:PA FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:16865-9553
Mailing Address - Country:US
Mailing Address - Phone:412-983-8826
Mailing Address - Fax:
Practice Address - Street 1:224 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-1716
Practice Address - Country:US
Practice Address - Phone:814-977-5345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASLO12338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASLO12338Medicaid