Provider Demographics
NPI:1114129020
Name:MITCHELL, JUDITH EILEEN (CNS,BC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:EILEEN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CNS,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 AUSTIN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-1201
Mailing Address - Country:US
Mailing Address - Phone:513-872-3315
Mailing Address - Fax:
Practice Address - Street 1:5467 CEDAR VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8693
Practice Address - Country:US
Practice Address - Phone:513-754-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS-04840163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338721Medicare ID - Type Unspecified