Kristan M. Bullock, M.S., CCC-SLP
NPI 1689082521ActiveIndividual· Speech-Language Pathologist· Idaho Falls, ID
Speech-Language Pathologist (M.S., CCC-SLP) with Foothills Rehabilitation and Performance Services PLLC and 1 other group, practicing in Idaho Falls, Idaho. Enrolled in Medicare as practitioner - qualified speech language pathologist.
Overview
| NPI | 1689082521 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | M.S., CCC-SLP |
| Sole proprietor | Yes |
| NPI issued | Jul 23, 2014 |
| Last updated in NPPES | Sep 15, 2014 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Speech-Language Pathologist Primary | 235Z00000X | SLP 2623 | ID |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Qualified Speech Language Pathologist (ID) |
|---|
Education and affiliations
| Graduation year | 2013 |
|---|---|
| Medicare specialty | Qualified Speech Language Pathologist |
Medical groups
- Foothills Rehabilitation and Performance Services PLLCIdaho Falls, ID · 8 clinicians
- Achieve Therapy and Learning Services, LLCIdaho Falls, ID · 8 clinicians
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All 88 speech-language pathologists in Idaho Falls · All speech-language pathologists in Idaho