MEDICARE: SANDRA J MULLENNIX

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	231H00000X	Audiologist	0462317	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225345663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA J MULLENNIX

Provider Business Mailing Address
First Line	:	3826 TOPSAIL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3826 TOPSAIL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5602
Country	:	US
Telephone Number	:	719-598-4819
Fax Number	:

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

Provider Enumeration Date	:	09/07/2010
Last Update Date	:	09/07/2010

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Directions to “ SANDRA J MULLENNIX ” Practice Location

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