Provider Demographics
NPI:1801118195
Name:ULICSNI, DIANE LEONA (C HT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LEONA
Last Name:ULICSNI
Suffix:
Gender:F
Credentials:C HT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15110 BOONES FERRY RD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3468
Mailing Address - Country:US
Mailing Address - Phone:503-699-6128
Mailing Address - Fax:503-582-1017
Practice Address - Street 1:15110 BOONES FERRY RD
Practice Address - Street 2:SUITE 245
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3468
Practice Address - Country:US
Practice Address - Phone:503-699-6128
Practice Address - Fax:503-582-1017
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist