Provider Demographics
NPI:1225585052
Name:MITCHELL, ASHLEY (SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 MILL ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1718
Mailing Address - Country:US
Mailing Address - Phone:812-639-1031
Mailing Address - Fax:
Practice Address - Street 1:1603 MILL ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1718
Practice Address - Country:US
Practice Address - Phone:812-639-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004245A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist