Provider Demographics
NPI:1285150920
Name:MUSUMHI, PAULA MONIQUE
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:MONIQUE
Last Name:MUSUMHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:MONIQUE
Other - Last Name:MAGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2511 S ILLINOIS AVE LOT 12
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-5944
Mailing Address - Country:US
Mailing Address - Phone:618-561-0167
Mailing Address - Fax:
Practice Address - Street 1:1725 SHOMAKER DR
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-2507
Practice Address - Country:US
Practice Address - Phone:618-684-2109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1073951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist