Provider Demographics
NPI:1437439858
Name:MULLING, SHERRY LAZENBY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LAZENBY
Last Name:MULLING
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 LAZENBY RD
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-8354
Mailing Address - Country:US
Mailing Address - Phone:601-545-2103
Mailing Address - Fax:
Practice Address - Street 1:54 LAZENBY RD
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-8354
Practice Address - Country:US
Practice Address - Phone:601-545-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS1027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist