Individual
MS. DESIREE D MUTCHERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,CCC/SLP
Contact information
Practice address
200 KEATS DR, 221, SPARTANBURG, SC 29301-4956
(813) 545-3042
Mailing address
PO BOX 310647, TAMPA, FL 33680-0647
(813) 545-3042
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5292
SC
235Z00000X
Speech-Language Pathologist
SA5247
FL
235Z00000X
Speech-Language Pathologist
SP-1568
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
681570796
—
FL
05
—
888523100
—
FL
Enumeration date
09/02/2006
Last updated
08/02/2016
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