=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790144764
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANNAH MULKEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2016
-----------------------------------------------------
Last Update Date | 02/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 865 HATCHELL LN
-----------------------------------------------------
City | DENHAM SPRINGS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70726-3019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-238-1741
-----------------------------------------------------
Fax | 225-341-8749
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2345
-----------------------------------------------------
City | DENHAM SPRINGS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70727-2345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-238-1741
-----------------------------------------------------
Fax | 225-341-8749
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH PATHOLOGIST
-----------------------------------------------------
Name | MRS. HANNAH MULKEY
-----------------------------------------------------
Credential | SLP
-----------------------------------------------------
Telephone | 225-247-3379
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 7523
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------