Provider Demographics
NPI:1073715348
Name:MIXON, MILTON BRET (BCBA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:BRET
Last Name:MIXON
Suffix:
Gender:M
Credentials:BCBA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 ROOD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2441
Mailing Address - Country:US
Mailing Address - Phone:970-245-7682
Mailing Address - Fax:
Practice Address - Street 1:321 ROOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2441
Practice Address - Country:US
Practice Address - Phone:970-245-7682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSLP.0001198OtherSTATE LICENSE
01111755OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION