Provider Demographics
NPI:1073938593
Name:MITCHELL, DENISE
Entity Type:Individual
Prefix:MRS
First Name:DENISE
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 1:2766 N GENOA CLAY CENTER RD
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:OH
Mailing Address - Zip Code:43430-9472
Mailing Address - Country:US
Mailing Address - Phone:419-855-7564
Mailing Address - Fax:
Practice Address - Street 1:2766 N GENOA CLAY CENTER RD
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:OH
Practice Address - Zip Code:43430-9472
Practice Address - Country:US
Practice Address - Phone:419-855-7564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP7160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist