Healthcare Provider Details

I. General information

NPI: 1093626921
Provider Name (Legal Business Name): MARY ULDRIKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1184 S 24TH ST
BATTLE CREEK MI
49015-2811
US

IV. Provider business mailing address

125 WALKER DR
BATTLE CREEK MI
49017-8833
US

V. Phone/Fax

Practice location:
  • Phone: 269-565-4900
  • Fax:
Mailing address:
  • Phone: 269-789-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101002987
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: