Provider Demographics
NPI:1780923771
Name:MULLINS, ANGELA NICOLE
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:NICOLE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 US HIGHWAY 80 E
Mailing Address - Street 2:STE 458B
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3359
Mailing Address - Country:US
Mailing Address - Phone:469-206-0652
Mailing Address - Fax:469-206-0739
Practice Address - Street 1:3939 US HIGHWAY 80 E
Practice Address - Street 2:STE 458B
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3359
Practice Address - Country:US
Practice Address - Phone:469-206-0652
Practice Address - Fax:469-206-0739
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106391235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist