Provider Demographics
NPI:1194086421
Name:MULLEN, KATHERINE KINGSBURY (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:KINGSBURY
Last Name:MULLEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:KITTY
Other - Middle Name:KINGSBURY
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2333 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5680
Mailing Address - Country:US
Mailing Address - Phone:214-659-1118
Mailing Address - Fax:
Practice Address - Street 1:2333 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5680
Practice Address - Country:US
Practice Address - Phone:214-659-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105667235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist