Provider Demographics
NPI:1629640024
Name:BULLOCK, CATHERINE (LICE TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:LICE TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 29TH ST SE APT C4
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-7778
Mailing Address - Country:US
Mailing Address - Phone:253-271-8217
Mailing Address - Fax:
Practice Address - Street 1:607 29TH ST SE APT C4
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-7778
Practice Address - Country:US
Practice Address - Phone:253-271-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA247200000247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other