Provider Demographics
NPI:1538273149
Name:MUELLER, ELIZABETH A (SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MUELLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 MERIDIAN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-3365
Mailing Address - Country:US
Mailing Address - Phone:618-624-8143
Mailing Address - Fax:618-624-8143
Practice Address - Street 1:723 INSIGHT AVE STE 300
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2193
Practice Address - Country:US
Practice Address - Phone:618-607-0086
Practice Address - Fax:618-607-0042
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist