Provider Demographics
NPI:1548743297
Name:MULLIGAN, KATE (AUD)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2509
Mailing Address - Country:US
Mailing Address - Phone:303-443-5085
Mailing Address - Fax:
Practice Address - Street 1:6700 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3405
Practice Address - Country:US
Practice Address - Phone:952-213-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD.0000923231H00000X
CAAU3694231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist