Provider Demographics
NPI:1003867995
Name:ULMER, JEFFREY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:ULMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CHEWUCH HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:WA
Mailing Address - Zip Code:98862-9140
Mailing Address - Country:US
Mailing Address - Phone:509-996-8210
Mailing Address - Fax:206-629-2150
Practice Address - Street 1:134 RIVERSIDE AVE STE D
Practice Address - Street 2:SUITE D
Practice Address - City:WINTHROP
Practice Address - State:WA
Practice Address - Zip Code:98862-5001
Practice Address - Country:US
Practice Address - Phone:509-996-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1675103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000120063Medicare PIN