Kenneth Jarred Bullock

NPI #1063977809 in Poplar Bluff, Missouri

Provider Information

NPI Number: 1063977809
Entity Type: Individual
Name: Kenneth Jarred Bullock
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Feb 6, 2019
Last Updated: Feb 6, 2019

Practice Location

Address: 3001 WARRIOR LN
City: Poplar Bluff
State: Missouri
ZIP Code: 63901-8685
Phone: (573) 686-1200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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