Provider Demographics
NPI:1093195505
Name:MIKEL, MARY KATELYNN (SLPA, BS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATELYNN
Last Name:MIKEL
Suffix:
Gender:F
Credentials:SLPA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 DONNELL BLVD STE Q
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36322-2111
Mailing Address - Country:US
Mailing Address - Phone:334-709-4386
Mailing Address - Fax:
Practice Address - Street 1:807 DONNELL BLVD STE Q
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36322-2111
Practice Address - Country:US
Practice Address - Phone:334-709-4386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant