Individual
JESSICA LEIGH BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16508 SE 24TH ST STE 204, VANCOUVER, WA 98683-4321
(503) 970-8092
Mailing address
16508 SE 24TH ST STE 204, VANCOUVER, WA 98683-4321
(503) 970-8092
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL61041281
WA
Other
Enumeration date
04/01/2020
Last updated
04/01/2020
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