Provider Demographics
NPI:1275962268
Name:BULLOCK, LAURA ROCK (AUD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ROCK
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:MICHELLE
Other - Last Name:ROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:4412 NEWLANDS ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4136
Mailing Address - Country:US
Mailing Address - Phone:504-908-8389
Mailing Address - Fax:
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5720
Practice Address - Country:US
Practice Address - Phone:504-896-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6967231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist