Provider Demographics
NPI:1629245592
Name:ULIS, DIANA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:ULIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 NEPTUNE AVE
Mailing Address - Street 2:16A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4065
Mailing Address - Country:US
Mailing Address - Phone:917-770-1916
Mailing Address - Fax:718-234-1703
Practice Address - Street 1:545 NEPTUNE AVE
Practice Address - Street 2:16A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4065
Practice Address - Country:US
Practice Address - Phone:917-770-1916
Practice Address - Fax:718-234-1703
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist