Provider Demographics
NPI:1073121422
Name:ULRICH, KIMBERLY HEADLE (RBT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:HEADLE
Last Name:ULRICH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16635 CENTERFIELD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7745
Mailing Address - Country:US
Mailing Address - Phone:907-694-6002
Mailing Address - Fax:
Practice Address - Street 1:16635 CENTERFIELD DR STE 103
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7745
Practice Address - Country:US
Practice Address - Phone:907-694-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician