Provider Demographics
NPI:1366638702
Name:MULLOY, KARA ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:ANN
Last Name:MULLOY
Suffix:
Gender:F
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 1:4640 BAIR AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1183
Mailing Address - Country:US
Mailing Address - Phone:402-742-7400
Mailing Address - Fax:402-742-9592
Practice Address - Street 1:4640 BAIR AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-1183
Practice Address - Country:US
Practice Address - Phone:402-742-7400
Practice Address - Fax:402-742-9592
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1137235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250113-00OtherMEDICAID