Provider Demographics
NPI:1811544117
Name:ULRICH, KELLY A (MA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:ULRICH
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 W SUPERIOR ST STE 600
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1869
Mailing Address - Country:US
Mailing Address - Phone:888-324-6205
Mailing Address - Fax:651-493-1105
Practice Address - Street 1:PO BOX 467
Practice Address - Street 2:
Practice Address - City:FINLAND
Practice Address - State:MN
Practice Address - Zip Code:55603-0467
Practice Address - Country:US
Practice Address - Phone:888-324-6205
Practice Address - Fax:651-493-1105
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor