Provider Demographics
NPI:1568674349
Name:ULITZSCH, CANDACE L (LISW)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:L
Last Name:ULITZSCH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 CUNNINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-1121
Mailing Address - Country:US
Mailing Address - Phone:513-894-7415
Mailing Address - Fax:
Practice Address - Street 1:140 N 5TH ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-3532
Practice Address - Country:US
Practice Address - Phone:513-863-6129
Practice Address - Fax:513-863-0524
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00090201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical