Provider Demographics
NPI:1306250089
Name:BULLOCK, LAUREN TATE
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:TATE
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:TATE
Other - Last Name:BRISCOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8550 CADENZA LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-4923
Mailing Address - Country:US
Mailing Address - Phone:214-328-4309
Mailing Address - Fax:214-328-7486
Practice Address - Street 1:8550 CADENZA LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-4923
Practice Address - Country:US
Practice Address - Phone:214-328-4309
Practice Address - Fax:214-328-7486
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist