Provider Demographics
NPI:1205112000
Name:MULLIN, STEPHANIE E (MHS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:E
Last Name:MULLIN
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:E
Other - Last Name:POPADIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS CCC-SLP
Mailing Address - Street 1:1753 KILAUEA AVE
Mailing Address - Street 2:D1
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-8003
Mailing Address - Country:US
Mailing Address - Phone:808-494-8933
Mailing Address - Fax:
Practice Address - Street 1:2148 AWAPUHI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5290
Practice Address - Country:US
Practice Address - Phone:808-365-8128
Practice Address - Fax:808-961-6383
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP 1190235Z00000X
235Z00000X
IN22004778A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist