Provider Demographics
NPI:1548697378
Name:KUPRAS, JOELLE (MSSP)
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:KUPRAS
Suffix:
Gender:F
Credentials:MSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3839 INVERNESS CMN
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-4906
Mailing Address - Country:US
Mailing Address - Phone:510-697-9526
Mailing Address - Fax:
Practice Address - Street 1:435 BOULDER CT
Practice Address - Street 2:SUITE 300
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-8326
Practice Address - Country:US
Practice Address - Phone:510-697-9526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 10489235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist