Provider Demographics
NPI:1609358134
Name:MUSHOLT, BRITTANY A (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:A
Last Name:MUSHOLT
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 1:609 W VEGA LN
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6527
Mailing Address - Country:US
Mailing Address - Phone:314-482-2381
Mailing Address - Fax:
Practice Address - Street 1:2201 S W S YOUNG DR STE 112-A2
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5317
Practice Address - Country:US
Practice Address - Phone:254-526-8255
Practice Address - Fax:254-526-2236
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111295235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist