Organization
EXPRESS YOURSELF THERAPEUTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE KUDLACIK (OWNER/SPEECH-LANGUAGE PATHOLOGIST)
(267) 587-7314
Entity
Organization
Contact information
Practice address
635 DUPONT ST UNIT M, PHILADELPHIA, PA 19128-2660
(518) 429-8404
Mailing address
635 DUPONT ST UNIT M, PHILADELPHIA, PA 19128-2660
(518) 429-8404
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811258718
—
PA
Enumeration date
03/31/2021
Last updated
03/31/2021
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