Susan Mary Ann Ultsch, M.S.,CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

6933 Issued in CA

Practice address

30 N San Pedro Rd
Suite 265
San Rafael, CA 94903-4118

Phone

(415) 479-7880

Fax

(415) 479-7889

NPI assigned

Apr 9, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sand Coast Rehab Physical Therapy Inc

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  • NPI 1639766603

  Speech-Language Pathologist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215050505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 SHORELINE HWY",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949413762",
            "telephone_number": "415-383-0121",
            "fax_number": "415-383-0121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N SAN PEDRO RD",
            "address_2": "SUITE 265",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949034118",
            "telephone_number": "415-479-7880",
            "fax_number": "415-479-7889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ULTSCH",
        "first_name": "SUSAN",
        "middle_name": "MARY ANN",
        "name_prefix": "Ms.",
        "credential": "M.S.,CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "6933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPEECH PATHOLOGY LICENSE",
            "identifier": "6933",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aria Twilling
• Thomas Joseph Uelk, DDS
• Tanya Uhl, CRNA
• Fernando Ulloa, M.D.
• Jody Lynn Ullom, MD
• Madeline Underwood, MD
• Haluk E Uner, RPH,MS
• Lynda Beth Unkeless
• Amy Nicole Urban
• Meghan C Urban

• Speech-Language Pathologist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.