Provider Demographics
NPI:1497911127
Name:ULMER, SUSAN DEWEY (MEDCCC-A)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DEWEY
Last Name:ULMER
Suffix:
Gender:F
Credentials:MEDCCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7275 GLEN FOREST DRIVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-288-8308
Mailing Address - Fax:804-288-7562
Practice Address - Street 1:7275 GLEN FOREST DRIVE
Practice Address - Street 2:SUITE 208
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-282-0022
Practice Address - Fax:804-282-2441
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101000813237700000X
VA2201000392231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist