Individual
MRS. STACEY BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
5150 STILESBORO RD NW STE 410, KENNESAW, GA 30152-7759
(770) 218-2300
Mailing address
5731 STONEKIRK WALK NW, ACWORTH, GA 30101-6920
(770) 975-8369
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006129
GA
Other
Enumeration date
07/30/2009
Last updated
07/30/2009
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