Provider Demographics
NPI:1265123921
Name:MULLEK, ANNA (MAS; MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MULLEK
Suffix:
Gender:F
Credentials:MAS; MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1583 SAVANNAH HWY STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7855
Mailing Address - Country:US
Mailing Address - Phone:854-205-6755
Mailing Address - Fax:
Practice Address - Street 1:1583 SAVANNAH HWY STE B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7855
Practice Address - Country:US
Practice Address - Phone:843-636-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist