Individual
KELLY LYN BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
870 E 9400 S STE 112, SANDY, UT 84094-3688
(801) 571-3081
Mailing address
870 E 9400 S, STE 112, SANDY, UT 84094-3666
(801) 840-4361
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6975681-4102
UT
Other
Enumeration date
07/22/2008
Last updated
12/22/2011
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