Provider Demographics
NPI:1740311976
Name:MULNO, HEATHER CHAKOS (MS-CSP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:CHAKOS
Last Name:MULNO
Suffix:
Gender:F
Credentials:MS-CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 W HOWE ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5428
Mailing Address - Country:US
Mailing Address - Phone:480-664-7667
Mailing Address - Fax:
Practice Address - Street 1:4650 WEST SWEETWATER AVENUE
Practice Address - Street 2:SPECIAL SERVICES
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304
Practice Address - Country:US
Practice Address - Phone:602-347-2653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist