Provider Demographics
NPI:1629172200
Name:MACMULLEN, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MACMULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:DURETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1822 N MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1350
Mailing Address - Country:US
Mailing Address - Phone:508-674-3334
Mailing Address - Fax:508-674-5855
Practice Address - Street 1:1822 N MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1350
Practice Address - Country:US
Practice Address - Phone:508-674-3334
Practice Address - Fax:508-674-5855
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAUD729237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5104343Medicaid
MAMA030064Medicare PIN