Healthcare Provider Details

I. General information

NPI: 1225945769
Provider Name (Legal Business Name): JENNIFER MULLINS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 COMMERCE RD STE 1
WEST BLOOMFIELD MI
48324-3293
US

IV. Provider business mailing address

14227 BANGOR DR
STERLING HEIGHTS MI
48313-5409
US

V. Phone/Fax

Practice location:
  • Phone: 248-865-3280
  • Fax:
Mailing address:
  • Phone: 586-337-0193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101001345
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: