Provider Demographics
NPI:1093434680
Name:MULLEN, KELSEY (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 OCOEE ST N
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4829
Mailing Address - Country:US
Mailing Address - Phone:423-641-0956
Mailing Address - Fax:
Practice Address - Street 1:4220 OCOEE ST N STE 102
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2395
Practice Address - Country:US
Practice Address - Phone:423-641-0956
Practice Address - Fax:423-641-0955
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2129237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter