Provider Demographics
NPI:1235463274
Name:ULTO, BERNICE (SLP)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:ULTO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:BERNICE
Other - Middle Name:
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1481 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3003
Mailing Address - Country:US
Mailing Address - Phone:917-880-6925
Mailing Address - Fax:
Practice Address - Street 1:1481 E 45TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3003
Practice Address - Country:US
Practice Address - Phone:917-880-6925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008794-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist