MEDICARE: SALLY E MUHLBACH AUD, CCC-A, FAAA

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	231H00000X	Audiologist	51152	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	0A4522	OTHER	TX	MEDICARE-GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902890734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY E MUHLBACH AUD, CCC-A, FAAA

Provider Business Mailing Address
First Line	:	609 E LUFKIN AVE
Second Line	:
City	:	LUFKIN
State	:	TX
Zip	:	75901-4043
Country	:	US
Telephone Number	:	936-632-2252
Fax Number	:	936-632-0712

Provider Business Practice Location Address
First Line	:	609 E LUFKIN AVE
Second Line	:
City	:	LUFKIN
State	:	TX
Zip	:	75901-4043
Country	:	US
Telephone Number	:	936-632-2252
Fax Number	:	936-632-0712

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/27/2010

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Directions to “ SALLY E MUHLBACH AUD, CCC-A, FAAA” Practice Location

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