Basic Information
| Provider Information | |||||||||
| NPI: | 1124526041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULCAHY | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | SLP, CCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5457 PINE LN | ||||||||
| Address2: | |||||||||
| City: | SOLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441391675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405902700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 346 ILLINOIS AVE | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440522106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402880448 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2018 | ||||||||
| LastUpdateDate: | 01/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP09381 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 2890135 | 05 | OH | MEDICAID |