Provider Demographics
NPI:1417519281
Name:WHEELER-BULLOCK, ABBY
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:WHEELER-BULLOCK
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 1:8072 FAIRFIELD FOREST RD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-9162
Mailing Address - Country:US
Mailing Address - Phone:704-491-0378
Mailing Address - Fax:
Practice Address - Street 1:858 2ND ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3877
Practice Address - Country:US
Practice Address - Phone:828-322-7826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist