Individual
KALISTA MAKENZIE MCMULLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
168 N 100 E STE 225, ST GEORGE, UT 84770-2893
(435) 669-4109
Mailing address
1751 RED MOUNTAIN DR, SANTA CLARA, UT 84765-5201
(435) 669-4109
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12975313-4104
UT
Other
Enumeration date
08/30/2022
Last updated
08/30/2022
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