Provider Demographics
NPI:1710179312
Name:ULAT, CRYSTAL (CCC-SLP MA)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:ULAT
Suffix:
Gender:F
Credentials:CCC-SLP MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58707-0001
Mailing Address - Country:US
Mailing Address - Phone:701-858-3030
Mailing Address - Fax:701-858-3032
Practice Address - Street 1:500 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58707-0001
Practice Address - Country:US
Practice Address - Phone:701-858-3030
Practice Address - Fax:701-858-3030
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist