Individual
ROBERT CHARLES ULLERICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2428 W REYNOLDS AVE, CENTRALIA, WA 98531-4554
(360) 330-9044
Mailing address
2428 W REYNOLDS AVE, CENTRALIA, WA 98531-4554
(360) 330-9044
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
175T00000X
Peer Specialist
Primary
CB61173850
WA
Other
Enumeration date
02/22/2021
Last updated
10/08/2024
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