Provider Demographics
NPI:1770612061
Name:BULLARD, CAREY LYNNE (SLP)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:LYNNE
Last Name:BULLARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 W FRIENDLY AVE # 274B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4274
Mailing Address - Country:US
Mailing Address - Phone:336-209-8147
Mailing Address - Fax:336-740-9099
Practice Address - Street 1:3907 W MARKET ST # A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1303
Practice Address - Country:US
Practice Address - Phone:336-209-8147
Practice Address - Fax:336-740-9099
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412896Medicaid
NC346635Medicare Oscar/Certification