Provider Demographics
NPI:1053523936
Name:MULLINAX, MONICA MARIE (MA CFY-SLP)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:MARIE
Last Name:MULLINAX
Suffix:
Gender:F
Credentials:MA CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 WESTRIDGE DR.
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069
Mailing Address - Country:US
Mailing Address - Phone:314-604-3556
Mailing Address - Fax:
Practice Address - Street 1:1773 W SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MO
Practice Address - Zip Code:63077-4420
Practice Address - Country:US
Practice Address - Phone:636-629-3571
Practice Address - Fax:636-629-6619
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006027168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2007021712OtherSTATE BOARD