Provider Demographics
NPI:1629802160
Name:BULLARD, BRIANA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:BULLARD
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 GREAT PARK DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-2033
Mailing Address - Country:US
Mailing Address - Phone:757-918-6461
Mailing Address - Fax:
Practice Address - Street 1:511 GREAT PARK DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-2033
Practice Address - Country:US
Practice Address - Phone:757-918-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202011156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty