Provider Demographics
NPI:1689928400
Name:ULRICH, KRISTINE R (LSP,CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:R
Last Name:ULRICH
Suffix:
Gender:F
Credentials:LSP,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 RABBIT RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-2814
Mailing Address - Country:US
Mailing Address - Phone:518-692-2187
Mailing Address - Fax:
Practice Address - Street 1:211 RABBIT RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-2814
Practice Address - Country:US
Practice Address - Phone:518-692-2187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist