Active NPI
Michael Kluk, M.B.A.,M.A., CCC-SLP
- Speech-Language Pathologist
- Tucson, AZ
National Provider Identifier
1447255237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1779
- Practice address
- 4877 N Territory Ave
Tucson, AZ 85750-5960 - Phone
- (520) 529-0285
- NPI assigned
- Jun 17, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 1779 | AZ | Primary |
Addresses
Primary practice location
4877 N Territory Ave
Tucson, AZ 85750-5960
Mailing address
4877 N Territory Ave
Tucson, AZ 85750-5960
Phone (520) 529-0285
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 957269 | Other | AZ | AHCCCS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts, Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1779 | AZ | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240444800000",
"number": "1447255237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4877 N TERRITORY AVE",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857505960",
"telephone_number": "520-529-0285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4877 N TERRITORY AVE",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857505960",
"telephone_number": "520-529-0285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLUK",
"first_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "M.B.A.,M.A., CCC-SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-17",
"last_updated": "2009-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AZ",
"license": "1779",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS",
"identifier": "957269",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.