Provider Demographics
NPI:1205458338
Name:MULLIGAN, JO-ANN P (MED)
Entity type:Individual
Prefix:
First Name:JO-ANN
Middle Name:P
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CHESTNUT CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3114
Mailing Address - Country:US
Mailing Address - Phone:603-568-6629
Mailing Address - Fax:
Practice Address - Street 1:20 HECKER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3975
Practice Address - Country:US
Practice Address - Phone:603-624-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist