Provider Demographics
NPI:1851714430
Name:USTIK, GARY (MS, CCC-SP)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:USTIK
Suffix:
Gender:M
Credentials:MS, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W WOOD ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44503-1028
Mailing Address - Country:US
Mailing Address - Phone:330-744-6900
Mailing Address - Fax:
Practice Address - Street 1:20 W WOOD ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44503-1028
Practice Address - Country:US
Practice Address - Phone:330-744-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-01
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-3089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist