Provider Demographics
NPI:1689086183
Name:MULLIS, SANDRA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MULLIS
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 1:530 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3524
Mailing Address - Country:US
Mailing Address - Phone:706-247-6630
Mailing Address - Fax:
Practice Address - Street 1:530 E 56TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3524
Practice Address - Country:US
Practice Address - Phone:706-247-6630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist