Provider Demographics
NPI:1003495060
Name:MARTIN, ULRIKE JENNIFER ERIKA (LISW)
Entity Type:Individual
Prefix:
First Name:ULRIKE
Middle Name:JENNIFER ERIKA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:ULRIKE
Other - Middle Name:JENNIFER
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:1970 N COUNTY ROAD 605
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-8981
Mailing Address - Country:US
Mailing Address - Phone:614-256-7521
Mailing Address - Fax:
Practice Address - Street 1:80 S COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9480
Practice Address - Country:US
Practice Address - Phone:740-330-4310
Practice Address - Fax:740-330-4330
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.21026001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical