Organization
PENNSYLVANIA STATE UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIMISHA MUTTIAH (SPEECH LANGUAGE PATHOLOGIST)
(419) 575-8034
Entity
Organization
Contact information
Practice address
110 FORD BLDG, THE PENNSYLVANIA STATE UNIVERSITY, UNIVERSITY PARK, PA 16802-3000
(814) 865-5414
Mailing address
1051 TEABERRY LN, D 206, STATE COLLEGE, PA 16803-2986
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
SL010567
PA
Other
Enumeration date
12/13/2011
Last updated
12/13/2011
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