Provider Demographics
NPI:1043495161
Name:ULMER, KIMBERLY SUSANNE (LAC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUSANNE
Last Name:ULMER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:S
Other - Last Name:ULMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:2800 E MADISON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4871
Mailing Address - Country:US
Mailing Address - Phone:206-384-1493
Mailing Address - Fax:
Practice Address - Street 1:2800 E MADISON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4871
Practice Address - Country:US
Practice Address - Phone:206-384-1493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002758171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist