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Organization
KLC PEDIATRIC THERAPY, LLC
Active
Organization
KLC PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACEY BULLOCK M.S., CCC-SLP (OWNER)
(214) 803-1699
Entity
Organization
Contact information
Practice address
1015 CHAMPIONS DR # 102, ALEDO, TX 76008-3206
(214) 803-1699
Mailing address
418 PRAIRIE RUN, ALEDO, TX 76008-1170
(214) 803-1699
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
08/16/2023
Last updated
08/17/2023
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