Provider Demographics
NPI:1285616482
Name:ULLRICH, KENNETH A (AUD MS)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:ULLRICH
Suffix:
Gender:M
Credentials:AUD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3027
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807-3027
Mailing Address - Country:US
Mailing Address - Phone:509-662-7143
Mailing Address - Fax:509-665-4301
Practice Address - Street 1:933 RED APPLE RD
Practice Address - Street 2:STE 100
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3370
Practice Address - Country:US
Practice Address - Phone:509-662-7143
Practice Address - Fax:509-665-4301
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAD00001397231H00000X
237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1043553Medicaid
WA1043553Medicaid
WAAB19359Medicare ID - Type Unspecified