1649304452 NPI number — PROF. WESLEY ALLEN BULLOCK PH.D.

Table of content: PROF. WESLEY ALLEN BULLOCK PH.D. (NPI 1649304452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649304452 NPI number — PROF. WESLEY ALLEN BULLOCK PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BULLOCK
Provider First Name:
WESLEY
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649304452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 W BANCROFT ST
Provider Second Line Business Mailing Address:
UNIVERSITY OF TOLEDO, DEPT. OF PSYCHOLOGY # 948
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43606-3328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-530-2721
Provider Business Mailing Address Fax Number:
419-530-8479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 W BANCROFT ST
Provider Second Line Business Practice Location Address:
UNIVERSITY OF TOLEDO, DEPT. OF PSYCHOLOGY # 948
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43606-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-530-2721
Provider Business Practice Location Address Fax Number:
419-530-8479
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  3856 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com