Healthcare Provider Details

I. General information

NPI: 1205224847
Provider Name (Legal Business Name): JACQUELINE MULLET M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 WARREN HILL RD
RICHMOND HILL GA
31324-6752
US

IV. Provider business mailing address

55 CANE PATCH LN
RICHMOND HILL GA
31324-7405
US

V. Phone/Fax

Practice location:
  • Phone: 912-459-5130
  • Fax:
Mailing address:
  • Phone: 330-730-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.9854
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: