Provider Demographics
NPI:1275059149
Name:BULLARD, ALONNA PATE
Entity Type:Individual
Prefix:
First Name:ALONNA
Middle Name:PATE
Last Name:BULLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1414
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28329-1414
Mailing Address - Country:US
Mailing Address - Phone:910-299-0700
Mailing Address - Fax:910-299-0800
Practice Address - Street 1:620 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3502
Practice Address - Country:US
Practice Address - Phone:910-299-0700
Practice Address - Fax:910-299-0800
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NC13100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist