Provider Demographics
NPI:1053864991
Name:MITCHELL, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1784 E NEIL CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8239
Mailing Address - Country:US
Mailing Address - Phone:301-802-8832
Mailing Address - Fax:
Practice Address - Street 1:161 KLEVIN ST
Practice Address - Street 2:STE 103
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1508
Practice Address - Country:US
Practice Address - Phone:907-561-8060
Practice Address - Fax:907-563-3172
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK113725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist