Provider Demographics
NPI:1275157174
Name:DULKA, JAMES W (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:DULKA
Suffix:
Gender:M
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BROADWAY N APT 207
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-5096
Mailing Address - Country:US
Mailing Address - Phone:701-412-4367
Mailing Address - Fax:
Practice Address - Street 1:1411 32ND ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6304
Practice Address - Country:US
Practice Address - Phone:701-532-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist