Provider Demographics
NPI:1730212986
Name:MUELLER, ERIN NICOLE LYNETTE (MS, CCC-SLP-L)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE LYNETTE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:MS, CCC-SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CARVER LN
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-3052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:309-387-2340
Practice Address - Street 1:110 CARVER LN
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-3052
Practice Address - Country:US
Practice Address - Phone:309-360-0707
Practice Address - Fax:309-387-2340
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist