Provider Demographics
NPI:1497780035
Name:SULC, CONSTANCE ELIZABETH (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:ELIZABETH
Last Name:SULC
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LAURA LANE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1680
Mailing Address - Country:US
Mailing Address - Phone:330-638-5434
Mailing Address - Fax:
Practice Address - Street 1:299 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502
Practice Address - Country:US
Practice Address - Phone:330-743-1168
Practice Address - Fax:330-743-1616
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP6975235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0078348Medicaid
OH0078348Medicaid