Basic Information
| Provider Information | |||||||||
| NPI: | 1780136929 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMULLEN | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Credential: | HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8800 SE SUNNYSIDE RD STE 300N | ||||||||
| Address2: | |||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970155703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123511529 | ||||||||
| FaxNumber: | 9522853980 | ||||||||
| Practice Location | |||||||||
| Address1: | 1585 RANDOLPH AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513937999 | ||||||||
| FaxNumber: | 6513937999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2016 | ||||||||
| LastUpdateDate: | 05/14/2018 | ||||||||
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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 | 237700000X | 2803 | MN | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237600000X | 2803 | MN | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.