Provider Demographics
NPI:1346304169
Name:ULRICH-SPITZER, DAWN MARIE (LP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:ULRICH-SPITZER
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N BROAD ST STE 308
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3569
Mailing Address - Country:US
Mailing Address - Phone:507-345-4448
Mailing Address - Fax:507-625-6829
Practice Address - Street 1:209 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-345-4448
Practice Address - Fax:507-625-1000
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3697103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN214467OtherCOMPSYCH
MN6020224400Medicaid
MN55AOSULOtherBLUE CROSS BLUE SHIELD
MN69695MAOtherBLUE CROSS BLUE SHIELD
MN120931OtherHEALTHPARTNERS
MN120931OtherU-CARE