Provider Demographics
NPI:1689795619
Name:CRIGGER MULLINS SPEECH THERAPY SERVICES PSC
Entity Type:Organization
Organization Name:CRIGGER MULLINS SPEECH THERAPY SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:DORTON
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:606-424-9176
Mailing Address - Street 1:PO BOX 1676
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240
Mailing Address - Country:US
Mailing Address - Phone:606-424-9176
Mailing Address - Fax:606-789-3059
Practice Address - Street 1:512 ELM ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240
Practice Address - Country:US
Practice Address - Phone:606-424-9176
Practice Address - Fax:606-789-3059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0112235Z00000X
KY0119235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty