Provider Demographics
NPI:1457717464
Name:MULLEN, BERNADETTE ERIN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ERIN
Last Name:MULLEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BETHANY RD
Mailing Address - Street 2:BUILDING 5 SUITE 60
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1663
Mailing Address - Country:US
Mailing Address - Phone:732-888-3912
Mailing Address - Fax:732-999-3916
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:BUILDING 5 SUITE 60
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1663
Practice Address - Country:US
Practice Address - Phone:732-888-3912
Practice Address - Fax:732-999-3916
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YSOO197000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist