Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kristan M Bullock, MS, CCC-SLP

Individual provider Speech-Language Pathologist · NPI 1689082521

Kristan M Bullock, MS, CCC-SLP is a Qualified Speech Language Pathologist in Idaho Falls, Idaho. Qualified in 2013, 13 years ago. Practices with Foothills Rehabilitation and Performance Services PLLC, an 8-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
13
Licensed in
ID
In the registry since
2014
What do these letters mean?
MS — Master of Science
A graduate science degree.
CCC-SLP — Certificate of Clinical Competence in Speech-Language Pathology
A speech-language pathologist certified by ASHA.

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Practice location Address checks out

3715 Woodking Dr
Idaho Falls, ID 83404-4720
Phone: (208) 529-2255
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence SLP 2623 (ID)

Record details

NPI number1689082521
Entity typeIndividual (Type 1)
GenderFemale
Credentials MS , CCC-SLP
Sole proprietorYes
NPI enumeratedJuly 23, 2014
Last updated in NPPESSeptember 15, 2014

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyQUALIFIED SPEECH LANGUAGE PATHOLOGIST
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Foothills Rehabilitation And Performance Services Pllc — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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