MEDICARE: HALLIE BULKIN MA, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	06297	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SLP000657	OTHER	DC	DC BOARD OF AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY
2	12112853	OTHER	MD	ASHA #
3	06297	OTHER	MD	MARYLAND STATE LICENSE IN SPEECH LANGUAGE PATHOLOGY

General Provider Information

NPI Number	:	1780022392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALLIE BULKIN MA, CCC-SLP

Provider Business Mailing Address
First Line	:	11908 BRISTOL MANOR CT
Second Line	:
City	:	N BETHESDA
State	:	MD
Zip	:	20852-5804
Country	:	US
Telephone Number	:	301-943-0920
Fax Number	:	240-206-3250

Provider Business Practice Location Address
First Line	:	11908 BRISTOL MANOR CT
Second Line	:
City	:	N BETHESDA
State	:	MD
Zip	:	20852-5804
Country	:	US
Telephone Number	:	301-943-0920
Fax Number	:	240-206-3250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	02/28/2014

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Directions to “ HALLIE BULKIN MA, CCC-SLP” Practice Location

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