Provider Demographics
NPI:1861746489
Name:MULLINS, STEVEN KYLE (CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:KYLE
Last Name:MULLINS
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 NICOLAUS DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8113
Mailing Address - Country:US
Mailing Address - Phone:601-731-0997
Mailing Address - Fax:
Practice Address - Street 1:63 NICOLAUS DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8113
Practice Address - Country:US
Practice Address - Phone:601-731-0997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSQMP000005828403OtherMOLINA
MS140249OtherUNITED HEALTHCARE
MS00387057Medicaid
MS09051792Medicaid