Provider Demographics
NPI:1003571613
Name:ULRICH, KELSIE DENNIS (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:DENNIS
Last Name:ULRICH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-4360
Mailing Address - Country:US
Mailing Address - Phone:334-318-2169
Mailing Address - Fax:
Practice Address - Street 1:115 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-3336
Practice Address - Country:US
Practice Address - Phone:334-491-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist