Provider Demographics
NPI:1124526041
Name:MULCAHY, SHARON J (SLP, CCC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:J
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5457 PINE LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1675
Mailing Address - Country:US
Mailing Address - Phone:440-590-2700
Mailing Address - Fax:
Practice Address - Street 1:346 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-2106
Practice Address - Country:US
Practice Address - Phone:440-288-0448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP09381235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2890135Medicaid