MEDICARE: REBECCA MULLINS M.A. CCC - SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP12044	AZ

General Provider Information

NPI Number	:	1205485653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MULLINS M.A. CCC - SLP

Provider Business Mailing Address
First Line	:	1600 W LA JOLLA DR APT 2065
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-4462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 W LA JOLLA DR APT 2065
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-4462
Country	:	US
Telephone Number	:	919-624-4916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2019
Last Update Date	:	09/09/2019

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