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NPI Code Detail

MEDICARE: JENNIFER BROOKE MULLINS CCC-SLP

MEDICARE: JENNIFER BROOKE 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
1235Z00000XSpeech-Language Pathologist140666999

General Provider Information

NPI Number : 1962885954
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER BROOKE MULLINS CCC-SLP
Provider Business Mailing Address
First Line : 8910 CROSSWIND CIR APT 102
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-8064
Country : US
Telephone Number : 334-590-7317
Fax Number :
Provider Business Practice Location Address
First Line : 340 MENDEL PKWY W
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-5406
Country : US
Telephone Number : 334-532-0220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2015
Last Update Date : 10/06/2015

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