Provider Demographics
NPI:1841590700
Name:ULRICH, GINA THERESA (MA CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:THERESA
Last Name:ULRICH
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 N CUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2602
Mailing Address - Country:US
Mailing Address - Phone:708-445-0978
Mailing Address - Fax:
Practice Address - Street 1:168 N CUYLER AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2602
Practice Address - Country:US
Practice Address - Phone:708-445-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.003674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist