Provider Demographics
NPI:1265861736
Name:MITCHELL, DANA SUZANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:SUZANNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:SUZANNE
Other - Last Name:BRYMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:630 BAY COVE DR
Mailing Address - Street 2:UNIT 411
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-5547
Mailing Address - Country:US
Mailing Address - Phone:239-216-7727
Mailing Address - Fax:
Practice Address - Street 1:6520 SUNSCOPE DR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-8690
Practice Address - Country:US
Practice Address - Phone:239-216-7727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist