Provider Demographics
NPI:1073314464
Name:MUELLER, TATYANA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:MUELLER
Suffix:
Gender:
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 FAIRBANKS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-4252
Mailing Address - Country:US
Mailing Address - Phone:515-310-0524
Mailing Address - Fax:
Practice Address - Street 1:1400 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5473
Practice Address - Country:US
Practice Address - Phone:507-594-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN529046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist