Provider Demographics
NPI:1477993418
Name:BULLA, LEANNE ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:ELIZABETH
Last Name:BULLA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:ELIZABETH
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3090 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5310
Mailing Address - Country:US
Mailing Address - Phone:719-574-8300
Mailing Address - Fax:719-574-9547
Practice Address - Street 1:3090 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5310
Practice Address - Country:US
Practice Address - Phone:719-574-8300
Practice Address - Fax:719-574-9547
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist