Provider Demographics
NPI:1588381099
Name:FOSTER BULLOCK, KENDALL (CD (DTI))
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:FOSTER BULLOCK
Suffix:
Gender:F
Credentials:CD (DTI)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 WILLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-8790
Mailing Address - Country:US
Mailing Address - Phone:720-937-5671
Mailing Address - Fax:
Practice Address - Street 1:1507 WILLOWBROOK DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-8790
Practice Address - Country:US
Practice Address - Phone:720-937-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula