Mary Bulloch, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202005384 Issued in VA

Practice address

21895 Crescent Park SQ
Apt 303
Broadlands, VA 20148-4434

Phone

(724) 433-9242

NPI assigned

Feb 12, 2011

Last updated

Feb 12, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297468800000",
    "number": "1093012908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21895 CRESCENT PARK SQ",
            "address_2": "APT 303",
            "city": "BROADLANDS",
            "state": "VA",
            "postal_code": "201484434",
            "telephone_number": "724-433-9242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21895 CRESCENT PARK SQ",
            "address_2": "APT 303",
            "city": "BROADLANDS",
            "state": "VA",
            "postal_code": "201484434",
            "telephone_number": "724-433-9242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCH",
        "first_name": "MARY",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-12",
        "last_updated": "2011-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202005384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• George Edward Burkett, MEDICAL MASSAGE
• Natalie Burns
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• Speech-Language Pathologist in Broadlands, VA
• Providers in Broadlands, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.