Provider Demographics
NPI:1851447254
Name:ULRICH, CLAIRE JEAN (MALP)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:JEAN
Last Name:ULRICH
Suffix:
Gender:F
Credentials:MALP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2227
Mailing Address - Country:US
Mailing Address - Phone:218-741-9460
Mailing Address - Fax:
Practice Address - Street 1:801 12TH ST N
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2227
Practice Address - Country:US
Practice Address - Phone:218-741-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2576103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN150J9ULOtherBLUE CROSS BLUE SHIELD #