Healthcare Provider Details

I. General information

NPI: 1548360522
Provider Name (Legal Business Name): CHERYL L KAISER-ULREY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 DAWSON RD
ALBANY GA
31707-3306
US

IV. Provider business mailing address

1908 DAWSON RD
ALBANY GA
31707-3306
US

V. Phone/Fax

Practice location:
  • Phone: 229-431-1107
  • Fax: 229-436-5042
Mailing address:
  • Phone: 229-431-1107
  • Fax: 229-436-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY002850
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: