KRISTAN M BULLOCK M.S., CCC-SLP
NPI 1689082521
Speech-Language Pathologist in Idaho Falls, ID

Q: What is Kristan Bullock's NPI number?

The NPI number for Kristan Bullock is 1689082521. It was assigned to this individual provider in the NPPES registry on July 23, 2014.

Q: What is Kristan Bullock's specialty?

The primary specialty registered for this NPI is Speech-Language Pathologist with taxonomy code 235Z00000X.

Q: When was this NPI record last updated?

The NPPES record for Kristan Bullock was last updated on September 15, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 23, 2014Accepts Medicare Assignment

3715 WOODKING DR, IDAHO FALLS, ID 83404(208) 529-2255 Get Directions Write a Review

NPPES record last updated: September 15, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Kristan M Bullock M.s., Ccc-slp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KRISTAN M BULLOCK M.S., CCC-SLP (NPI 1689082521) is an individual speech-language pathologist provider in Idaho Falls, Idaho, licensed in Idaho (SLP 2623) and active in the NPI registry since July 2014. She is a graduate of Other (2013).

NPPES Registry Identity

NPI1689082521

Entity TypeIndividualFemale

Primary Taxonomy235Z00000X

Provider Legal NameKRISTAN M BULLOCKCredential: M.S., CCC-SLP

Location Address3715 WOODKING DRIdaho Falls, ID 83404-4720

Mailing Address2094 Autumn LnIdaho Falls, ID 83404-8287 · (208) 881-1309

Phone(208) 529-2255

Sole ProprietorYes

Medical School CMSOtherGraduated 2013

Enumeration DateJuly 23, 2014

Last NPPES UpdateSeptember 15, 2014

✔ NPI 1689082521 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpeech-Language PathologistSpeech, Language and Hearing Service Providers

Taxonomy Code235Z00000X

License✔ Licensed in ID · SLP 2623

Definition

The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.

3715 WOODKING DR, Idaho Falls, ID 83404

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., PacificSource Health Plans, Providence Health Plan and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kristan M Bullock M.s., Ccc-slp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4385865575

PECOS Enrollment IDI20141103000900

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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