Provider Demographics
NPI:1649508599
Name:ULLERY, VIRGINIA SYLVIA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:SYLVIA
Last Name:ULLERY
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:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:VT
Mailing Address - Zip Code:05860-0133
Mailing Address - Country:US
Mailing Address - Phone:802-673-4849
Mailing Address - Fax:
Practice Address - Street 1:3090 HOLLOW ROAD
Practice Address - Street 2:
Practice Address - City:BARTON
Practice Address - State:VT
Practice Address - Zip Code:05822
Practice Address - Country:US
Practice Address - Phone:802-673-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8032189235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist