Provider Demographics
NPI:1437974730
Name:KUCLO, STEPHEN (IHP L2, HPH, EMT-P)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:KUCLO
Suffix:
Gender:M
Credentials:IHP L2, HPH, EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 REPUBLICAN BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9825
Mailing Address - Country:US
Mailing Address - Phone:469-999-6985
Mailing Address - Fax:
Practice Address - Street 1:16633 DALLAS PKWY STE 150
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6812
Practice Address - Country:US
Practice Address - Phone:469-999-6985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276794406175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath