Provider Demographics
NPI:1073854907
Name:MITCHELL, MARYANN P (MA SLP-CFY)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:P
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5447 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-4009
Mailing Address - Country:US
Mailing Address - Phone:313-832-1100
Mailing Address - Fax:
Practice Address - Street 1:19505 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1643
Practice Address - Country:US
Practice Address - Phone:313-832-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist