Provider Demographics
NPI:1689406191
Name:THREADGILL, MILDRED HAROLYN (AUD)
Entity type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:HAROLYN
Last Name:THREADGILL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 SAINT VINCENTS DR STE 402
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1613
Mailing Address - Country:US
Mailing Address - Phone:205-212-3546
Mailing Address - Fax:
Practice Address - Street 1:833 SAINT VINCENTS DR STE 402
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1613
Practice Address - Country:US
Practice Address - Phone:205-212-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1389A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist