Healthcare Provider Details

I. General information

NPI: 1801289723
Provider Name (Legal Business Name): MUELLER PEDIATRIC THERAPY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E WASHINGTON ST
EAST PEORIA IL
61611-2663
US

IV. Provider business mailing address

411 E WASHINGTON ST
EAST PEORIA IL
61611-2663
US

V. Phone/Fax

Practice location:
  • Phone: 309-282-6704
  • Fax: 309-387-2340
Mailing address:
  • Phone: 309-282-6704
  • Fax: 309-387-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149007677
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146008528
License Number StateIL

VIII. Authorized Official

Name: ERIN MUELLER
Title or Position: OWNER/SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 309-282-6704