Provider Demographics
NPI:1780022392
Name:BULKIN, HALLIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:BULKIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:
Other - Last Name:FREEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:11908 BRISTOL MANOR CT
Mailing Address - Street 2:
Mailing Address - City:N BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-5804
Mailing Address - Country:US
Mailing Address - Phone:301-943-0920
Mailing Address - Fax:240-206-3250
Practice Address - Street 1:11908 BRISTOL MANOR CT
Practice Address - Street 2:
Practice Address - City:N BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-5804
Practice Address - Country:US
Practice Address - Phone:301-943-0920
Practice Address - Fax:240-206-3250
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCSLP000657OtherDC BOARD OF AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY
MD12112853OtherASHA #
MD06297OtherMARYLAND STATE LICENSE IN SPEECH LANGUAGE PATHOLOGY