Provider Demographics
NPI:1235404401
Name:MITCHELL, LISA JOHNSTON (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JOHNSTON
Last Name:MITCHELL
Suffix:
Gender:F
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 1:8257 TRADD CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-7297
Mailing Address - Country:US
Mailing Address - Phone:704-575-2670
Mailing Address - Fax:704-553-7587
Practice Address - Street 1:8257 TRADD CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-7297
Practice Address - Country:US
Practice Address - Phone:704-575-2670
Practice Address - Fax:704-553-7587
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8173235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist