Provider Demographics
NPI:1285228783
Name:MULLINS, SAMANTHA L (SLPA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:MULLINS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5893 AZELEA DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016-2002
Mailing Address - Country:US
Mailing Address - Phone:314-620-6588
Mailing Address - Fax:
Practice Address - Street 1:7432 MARILLAC DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4744
Practice Address - Country:US
Practice Address - Phone:314-495-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019033116237700000X
2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist