1598895815 NPI number — JEAN MACAULAY MULLER MS CCC SLP

Table of content: JEAN MACAULAY MULLER MS CCC SLP (NPI 1598895815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598895815 NPI number — JEAN MACAULAY MULLER MS CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLER
Provider First Name:
JEAN
Provider Middle Name:
MACAULAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACAULAY
Provider Other First Name:
JEAN
Provider Other Middle Name:
LYNN
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:
1598895815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2210 LELARAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLO SPGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-475-0477
Provider Business Mailing Address Fax Number:
719-475-1021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2210 LELARAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLO SPGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-475-0477
Provider Business Practice Location Address Fax Number:
719-475-1021
Provider Enumeration Date:
03/06/2007

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: 235Z00000X , with the licence number:  ASHA01092654 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41006241 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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