Provider Demographics
NPI:1831312115
Name:MUELLER, ELIZABETH MUELLER ANN
Entity Type:Individual
Prefix:
First Name:ELIZABETH MUELLER
Middle Name:ANN
Last Name:MUELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 N PRESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3317
Mailing Address - Country:US
Mailing Address - Phone:928-692-7612
Mailing Address - Fax:
Practice Address - Street 1:3033 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4235
Practice Address - Country:US
Practice Address - Phone:928-753-5678
Practice Address - Fax:928-753-6910
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL1152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ562571Medicaid