Individual
MRS. MIRANDA WYNN BULLOCK-DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CFY-SLP
Contact information
Practice address
1001 MONARCH ST, STE. 110, LEXINGTON, KY 40513-1495
(859) 224-0834
Mailing address
1001 MONARCH ST, STE. 110, LEXINGTON, KY 40513-1495
(859) 224-0834
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
10-027
KY
Other
Enumeration date
05/12/2010
Last updated
05/12/2010
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