Provider Demographics
NPI:1174781041
Name:MULLEN, EDWARD (SLP)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 BENNETT AVE APT 407
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3024
Mailing Address - Country:US
Mailing Address - Phone:347-920-7040
Mailing Address - Fax:
Practice Address - Street 1:69 BENNETT AVE APT 407
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3024
Practice Address - Country:US
Practice Address - Phone:347-920-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014433-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist