Provider Demographics
NPI:1891394565
Name:NULPH, BONNIE (SLP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:NULPH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 LOMBARD CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-6858
Mailing Address - Country:US
Mailing Address - Phone:214-762-6780
Mailing Address - Fax:
Practice Address - Street 1:6010 LOMBARD CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-6858
Practice Address - Country:US
Practice Address - Phone:214-762-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist