Provider Demographics
NPI:1508425398
Name:MULLINS, KACIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:MULLINS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KACIE
Other - Middle Name:
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:716 INDIAN TRL STE 140
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5702
Mailing Address - Country:US
Mailing Address - Phone:254-213-2952
Mailing Address - Fax:866-459-0530
Practice Address - Street 1:716 INDIAN TRL STE 140
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5702
Practice Address - Country:US
Practice Address - Phone:254-213-2952
Practice Address - Fax:866-459-0530
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108110235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist