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NPI Code Detail

MEDICARE: MARY ANN MUDD M.S. CCC-SLP

MEDICARE: MARY ANN MUDD M.S. 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
1235Z00000XSpeech-Language Pathologist0731KY

General Provider Information

NPI Number : 1689701187
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ANN MUDD M.S. CCC-SLP
Provider Business Mailing Address
First Line : 104 BELLEMEADE RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40222-5310
Country : US
Telephone Number : 502-429-6109
Fax Number :
Provider Business Practice Location Address
First Line : 9810 BLUEGRASS PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-1906
Country : US
Telephone Number : 502-584-9781
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2007
Last Update Date : 07/08/2007

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Directions to “ MARY ANN MUDD M.S. CCC-SLP” Practice Location

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