Healthcare Provider Details

I. General information

NPI: 1104735208
Provider Name (Legal Business Name): SYDNEY BULLOCK LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8989 HURON ST
THORNTON CO
80260-6858
US

IV. Provider business mailing address

1870 W 122ND AVE STE 100
WESTMINSTER CO
80234-2075
US

V. Phone/Fax

Practice location:
  • Phone: 303-853-3686
  • Fax:
Mailing address:
  • Phone: 303-853-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: