Individual
MRS. INGRID VANESSA BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP-CCC
Contact information
Practice address
4354 TOKOSE PL, LAKELAND, FL 33811-1430
(813) 416-7148
Mailing address
4354 TOKOSE PL, LAKELAND, FL 33811-1430
(813) 416-7148
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA8474
FL
Other
Enumeration date
03/03/2008
Last updated
03/03/2008
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