Provider Demographics
NPI:1255468385
Name:ULIBARRI, HEATHER (ISC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:ULIBARRI
Suffix:
Gender:F
Credentials:ISC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4462
Mailing Address - Country:US
Mailing Address - Phone:307-362-1627
Mailing Address - Fax:307-362-1627
Practice Address - Street 1:1718 KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4462
Practice Address - Country:US
Practice Address - Phone:307-362-1627
Practice Address - Fax:307-362-1627
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services