Basic Information
| Provider Information | |||||||||
| NPI: | 1548634595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KULAS | ||||||||
| FirstName: | JACOB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8901 W CAPITOL DR | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532221706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144631880 | ||||||||
| FaxNumber: | 4144632770 | ||||||||
| Practice Location | |||||||||
| Address1: | 8901 W CAPITOL DR | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144631880 | ||||||||
| FaxNumber: | 4144632770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2015 | ||||||||
| LastUpdateDate: | 10/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6417-125 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.