Provider Demographics
NPI:1316112139
Name:MUELLER PEDIATRIC THERAPY, LTD.
Entity type:Organization
Organization Name:MUELLER PEDIATRIC THERAPY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:NICOLE LYNETTE
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP/L
Authorized Official - Phone:309-282-6704
Mailing Address - Street 1:411 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-2663
Mailing Address - Country:US
Mailing Address - Phone:309-282-6704
Mailing Address - Fax:309-387-2340
Practice Address - Street 1:411 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-2663
Practice Address - Country:US
Practice Address - Phone:309-282-6704
Practice Address - Fax:309-387-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty