Provider Demographics
NPI:1194023283
Name:MITCHELL, SIMON JAMES (CCC, SLP)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:JAMES
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11555 HERON BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3360
Mailing Address - Country:US
Mailing Address - Phone:954-425-2534
Mailing Address - Fax:
Practice Address - Street 1:11555 HERON BAY BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3360
Practice Address - Country:US
Practice Address - Phone:954-425-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10885235Z00000X
FLSA 10885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist