Provider Demographics
NPI:1245402247
Name:MULLICAN, MEGAN MCDANIEL (FAAA, CC-A, MS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MCDANIEL
Last Name:MULLICAN
Suffix:
Gender:F
Credentials:FAAA, CC-A, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-579-5463
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:1605 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3110
Practice Address - Country:US
Practice Address - Phone:601-579-3310
Practice Address - Fax:601-264-0231
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA0622231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00791976OtherRAILROAD MEDICARE
MSP00791976OtherRAILROAD MEDICARE