Healthcare Provider Details

I. General information

NPI: 1811852585
Provider Name (Legal Business Name): JOEL A BULLARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 NE HOOD AVE
GRESHAM OR
97030-7450
US

IV. Provider business mailing address

304 NE HOOD AVE
GRESHAM OR
97030-7450
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-1333
  • Fax: 503-666-2444
Mailing address:
  • Phone: 503-666-1333
  • Fax: 503-666-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18618
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: