Provider Demographics
NPI:1285656702
Name:MULLINS, TRACY ANNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANNE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 DOUGLAS FIRR CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7445
Mailing Address - Country:US
Mailing Address - Phone:513-574-4612
Mailing Address - Fax:513-574-4612
Practice Address - Street 1:5409 DOUGLAS FIRR CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7445
Practice Address - Country:US
Practice Address - Phone:513-574-4612
Practice Address - Fax:513-574-4612
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 8513235Z00000X
KY3358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187155Medicaid
OH9360731Medicare ID - Type Unspecified