Provider Demographics
NPI:1780980037
Name:ULLSTRUP, CHRISTINE (LCSW, CSAC, ICS)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:ULLSTRUP
Suffix:
Gender:F
Credentials:LCSW, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 N BREMEN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3003
Mailing Address - Country:US
Mailing Address - Phone:414-962-1200
Mailing Address - Fax:
Practice Address - Street 1:2618 N BREMEN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3003
Practice Address - Country:US
Practice Address - Phone:414-962-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11148-132101YA0400X
WI7670-1231041C0700X
WI14517-1351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical