Healthcare Provider Details

I. General information

NPI: 1023138005
Provider Name (Legal Business Name): JONI SKINNER BULLOUGH AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ROUND HILL RD CLARKE SCHOOL CENTER FOR AUDIOLOGICAL SERVICES
NORTHAMPTON MA
01060-2123
US

IV. Provider business mailing address

181 NORTHAMPTON ST STE. F
EASTHAMPTON MA
01027-1181
US

V. Phone/Fax

Practice location:
  • Phone: 413-582-1114
  • Fax:
Mailing address:
  • Phone: 413-221-7423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number782
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: