Healthcare Provider Details

I. General information

NPI: 1316112139
Provider Name (Legal Business Name): MUELLER PEDIATRIC THERAPY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 03/26/2015
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 TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146008528
License Number StateIL

VIII. Authorized Official

Name: MRS. ERIN NICOLE LYNETTE MUELLER
Title or Position: PRESIDENT/ SLP
Credential: M.S. CCC-SLP/L
Phone: 309-282-6704