Provider Demographics
NPI:1669896429
Name:ULRICH, KRISTIN (SLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ULRICH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:GILLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:29805 ELECTRIC DR
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-1223
Mailing Address - Country:US
Mailing Address - Phone:440-864-6431
Mailing Address - Fax:
Practice Address - Street 1:23 ERIC NORD WAY
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1582
Practice Address - Country:US
Practice Address - Phone:440-207-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-6329235Z00000X
OHSP6329235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist