Healthcare Provider Details

I. General information

NPI: 1962328179
Provider Name (Legal Business Name): MRS. JESSICA ANN ULRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4607 580TH AVE
WEST BEND IA
50597-8000
US

IV. Provider business mailing address

4607 580TH AVE
WEST BEND IA
50597-8000
US

V. Phone/Fax

Practice location:
  • Phone: 515-369-0034
  • Fax: 844-381-0919
Mailing address:
  • Phone: 515-369-0034
  • Fax: 844-381-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number084788
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: