MEDICARE: KENNETH KURT MUELLAUER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.175448	OH

General Provider Information

NPI Number	:	1801462148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH KURT MUELLAUER

Provider Business Mailing Address
First Line	:	15600 NORWAY AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-1963
Country	:	US
Telephone Number	:	121-667-1574
Fax Number	:

Provider Business Practice Location Address
First Line	:	15600 NORWAY AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-1963
Country	:	US
Telephone Number	:	216-671-5740
Fax Number	:

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

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	05/27/2021

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