Individual
OWEN MULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ST
Contact information
Practice address
1635 BOLING ST, JACKSON, MS 39213-4418
(601) 366-0123
(601) 366-0649
Mailing address
1635 BOLING ST, JACKSON, MS 39213-4418
(601) 366-0123
(601) 366-0649
Taxonomy
Speciality
Code
Description
License number
State
235500000X
Speech/Language/Hearing Specialist/Technologist
Primary
S2779
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03921787
—
MS
05
—
06081560
—
MS
Enumeration date
01/14/2007
Last updated
04/02/2008
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