Provider Demographics
NPI:1639532591
Name:ULMER, KRISTEN ELAINE (MSW, ASW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ELAINE
Last Name:ULMER
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:ELAINE
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-2076
Mailing Address - Country:US
Mailing Address - Phone:909-435-5663
Mailing Address - Fax:909-363-9202
Practice Address - Street 1:127 E STATE ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4755
Practice Address - Country:US
Practice Address - Phone:909-435-5663
Practice Address - Fax:909-363-9202
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical