1295073856 NPI number — CATHERINE LYNN MULLIN SLPA

Table of content: CATHERINE LYNN MULLIN SLPA (NPI 1295073856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295073856 NPI number — CATHERINE LYNN MULLIN SLPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLIN
Provider First Name:
CATHERINE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENRY
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295073856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
430 OLDS STATION RD.
Provider Second Line Business Mailing Address:
P.O. BOX 1847
Provider Business Mailing Address City Name:
WENATCHEE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-665-2610
Provider Business Mailing Address Fax Number:
509-662-9027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 TACOMA AVE.
Provider Second Line Business Practice Location Address:
BRIDGEPORT SCHOOL DISTRICT
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-686-5656
Provider Business Practice Location Address Fax Number:
509-686-2221
Provider Enumeration Date:
01/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X , with the licence number:  SP60246219 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SP60246219 . This is a "SLPA CERTIFICATION" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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