Individual
GWYNETTA BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1801 E SHADY OAK DR, PEORIA, IL 61614-7907
(309) 686-1948
Mailing address
1801 E SHADY OAK DR, PEORIA, IL 61614-7907
(309) 686-1948
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
09/06/2017
Last updated
07/21/2022
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