Provider Demographics
NPI:1093875874
Name:MULLEN, MARY JANE
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY JANE
Other - Middle Name:
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSSP, CCC-SLP
Mailing Address - Street 1:51 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1846
Mailing Address - Country:US
Mailing Address - Phone:508-238-1523
Mailing Address - Fax:
Practice Address - Street 1:17 COCASSET ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2948
Practice Address - Country:US
Practice Address - Phone:508-698-3709
Practice Address - Fax:508-698-3785
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist