1689795619 NPI number — CRIGGER MULLINS SPEECH THERAPY SERVICES PSC

Table of content: (NPI 1689795619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689795619 NPI number — CRIGGER MULLINS SPEECH THERAPY SERVICES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRIGGER MULLINS SPEECH THERAPY SERVICES PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689795619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1676
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAINTSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-424-9176
Provider Business Mailing Address Fax Number:
606-789-3059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
512 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAINTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-424-9176
Provider Business Practice Location Address Fax Number:
606-789-3059
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MULLINS
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
DORTON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
606-424-9176

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  0112 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 0119 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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