Provider Demographics
NPI:1750337747
Name:ULRICH, THERESA LOUISE (MSW, LISW-S)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LOUISE
Last Name:ULRICH
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1220
Mailing Address - Country:US
Mailing Address - Phone:740-452-1784
Mailing Address - Fax:740-452-1784
Practice Address - Street 1:930 BETHESDA DR UNIT 4
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-0815
Practice Address - Country:US
Practice Address - Phone:740-452-4848
Practice Address - Fax:740-452-4848
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI28001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ULSW21131Medicare ID - Type Unspecified