Provider Demographics
NPI:1376940726
Name:PULLEN, MONET (MSP,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MONET
Middle Name:
Last Name:PULLEN
Suffix:
Gender:F
Credentials:MSP,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-9765
Mailing Address - Country:US
Mailing Address - Phone:803-271-4064
Mailing Address - Fax:
Practice Address - Street 1:154 ANDERSON DR
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-9765
Practice Address - Country:US
Practice Address - Phone:803-271-4064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist