Provider Demographics
NPI:1598130718
Name:BULLOCK, CATHERINE ELIZABETH (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ELIZABETH ROWLAND
Other - Last Name:BULLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA CF-SLP
Mailing Address - Street 1:261 WHITLEY TRAIL SUBDIVISION
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-9440
Mailing Address - Country:US
Mailing Address - Phone:606-682-9579
Mailing Address - Fax:
Practice Address - Street 1:261 WHITLEY TRAIL SUBDIVISION
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-9440
Practice Address - Country:US
Practice Address - Phone:606-682-9579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSLPIN00218789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist