Provider Demographics
NPI:1912361817
Name:MULLEN, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MULLEN
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 1:16356 KARLSTAD AVE
Mailing Address - Street 2:
Mailing Address - City:KILKENNY
Mailing Address - State:MN
Mailing Address - Zip Code:56052-9621
Mailing Address - Country:US
Mailing Address - Phone:952-758-2722
Mailing Address - Fax:
Practice Address - Street 1:115 1ST AVE SE
Practice Address - Street 2:SUITE #100
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2503
Practice Address - Country:US
Practice Address - Phone:952-758-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2298237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist