MEDICARE: TRACY ANNE MULLINS 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	SP 8513	OH
2	235Z00000X	Speech-Language Pathologist	3358	KY

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	:	1285656702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY ANNE MULLINS CCC-SLP

Provider Business Mailing Address
First Line	:	5409 DOUGLAS FIRR CT
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7445
Country	:	US
Telephone Number	:	513-574-4612
Fax Number	:	513-574-4612

Provider Business Practice Location Address
First Line	:	5409 DOUGLAS FIRR CT
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7445
Country	:	US
Telephone Number	:	513-574-4612
Fax Number	:	513-574-4612

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/14/2009

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