Individual
SHANE BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5456 ARCHES DR, SALT LAKE CITY, UT 84129-1704
(801) 815-2833
Mailing address
5456 ARCHES DR, SALT LAKE CITY, UT 84129-1704
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
07/29/2012
Last updated
07/29/2012
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