Basic Information
| Provider Information | |||||||||
| NPI: | 1912229246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULVEY | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2238 E. GINTER ROAD | ||||||||
| Address2: | SUNNYSIDE UNIFIED SCHOOL DISTRICT NO. 12 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205452137 | ||||||||
| FaxNumber: | 5205452024 | ||||||||
| Practice Location | |||||||||
| Address1: | 2238 E. GINTER ROAD | ||||||||
| Address2: | SUNNYSIDE UNIFIED SCHOOL DISTRICT NO. 12 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205452137 | ||||||||
| FaxNumber: | 5205452024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2010 | ||||||||
| LastUpdateDate: | 11/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | AZ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 978098 | 05 | AZ | MEDICAID | SLP7077 | 01 | AZ | AZ DEPT HEALTH SERVICE | OTHER |