Provider Demographics
NPI:1447351218
Name:MULFORD, NICKI MARYANN (AUD)
Entity type:Individual
Prefix:MISS
First Name:NICKI
Middle Name:MARYANN
Last Name:MULFORD
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 1:124 HAYMAC DR
Mailing Address - Street 2:
Mailing Address - City:PARCHMENT
Mailing Address - State:MI
Mailing Address - Zip Code:49004-1733
Mailing Address - Country:US
Mailing Address - Phone:269-382-6975
Mailing Address - Fax:
Practice Address - Street 1:1634 GULL RD
Practice Address - Street 2:SUITE1
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1632
Practice Address - Country:US
Practice Address - Phone:269-343-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000062231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4793848Medicaid
MI4678265Medicaid