Healthcare Provider Details

I. General information

NPI: 1790480655
Provider Name (Legal Business Name): MS. DEANNA BULSINK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26407 OAK RIDGE DR
SPRING TX
77380-1964
US

IV. Provider business mailing address

1835 WOODLAND FIELD XING APT 266
THE WOODLANDS TX
77380-3852
US

V. Phone/Fax

Practice location:
  • Phone: 281-363-2270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number42936
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: