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General NPI Number Information
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NPI Number | 1962504662
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Entity Type | Individual
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Provider Name | DESIREE D MUTCHERSON MS,CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 200 KEATS DR 221
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City | SPARTANBURG
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State | SC
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Zip | 29301-4956
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Country | US
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Telephone | 813-545-3042
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 310647
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City | TAMPA
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State | FL
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Zip | 33680-0647
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Country | US
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Telephone | 813-545-3042
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA5247
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 5292
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP-1568
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License Number State | HI
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