MEDICARE: DR. JEFFREY M ULMER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1675	WA

General Provider Information

NPI Number	:	1003867995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY M ULMER PHD

Provider Business Mailing Address
First Line	:	42 CHEWUCH HEIGHTS RD
Second Line	:
City	:	WINTHROP
State	:	WA
Zip	:	98862-9140
Country	:	US
Telephone Number	:	509-996-8210
Fax Number	:	206-629-2150

Provider Business Practice Location Address
First Line	:	134 RIVERSIDE AVE STE D
Second Line	:	SUITE D
City	:	WINTHROP
State	:	WA
Zip	:	98862-5001
Country	:	US
Telephone Number	:	509-996-2606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	03/14/2014

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