Provider Demographics
NPI:1497546691
Name:MULLENBERG, MARIAH
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:MULLENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HENNEPIN AVE
Mailing Address - Street 2:APT W604
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403
Mailing Address - Country:US
Mailing Address - Phone:952-388-3453
Mailing Address - Fax:
Practice Address - Street 1:5700 E RIVER RD
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-6149
Practice Address - Country:US
Practice Address - Phone:763-571-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist