Provider Demographics
NPI:1174842256
Name:KULYK, TRACY WESTER (MSP CCC-SLP, MED)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:WESTER
Last Name:KULYK
Suffix:
Gender:F
Credentials:MSP CCC-SLP, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5952 CENTRAL CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:VERNON CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13477-3716
Mailing Address - Country:US
Mailing Address - Phone:315-829-3292
Mailing Address - Fax:
Practice Address - Street 1:75 CHENANGO AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1340
Practice Address - Country:US
Practice Address - Phone:315-557-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016401-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist