Provider Demographics
NPI:1720513773
Name:ULLMAN, TESSA
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:ULLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6261 SW 24TH PL APT 310
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1160
Mailing Address - Country:US
Mailing Address - Phone:714-345-1562
Mailing Address - Fax:
Practice Address - Street 1:6261 SW 24TH PL APT 310
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1160
Practice Address - Country:US
Practice Address - Phone:714-345-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist