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NPI Code Detail

MEDICARE: CHRISTINE ULLSTRUP LCSW, CSAC, ICS

MEDICARE: CHRISTINE ULLSTRUP LCSW, CSAC, ICS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor11148-132WI
21041C0700XClinical Social Worker7670-123WI
31041C0700XClinical Social Worker14517-135WI

General Provider Information

NPI Number : 1780980037
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE ULLSTRUP LCSW, CSAC, ICS
Provider Business Mailing Address
First Line : 2618 N BREMEN ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-3003
Country : US
Telephone Number : 414-962-1200
Fax Number :
Provider Business Practice Location Address
First Line : 2618 N BREMEN ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-3003
Country : US
Telephone Number : 414-962-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2011
Last Update Date : 02/03/2011

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