Provider Demographics
NPI:1275955684
Name:MITCHELL, KERSHONA E (MA, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:KERSHONA
Middle Name:E
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 ANCHOR WAY
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-1304
Mailing Address - Country:US
Mailing Address - Phone:516-564-7550
Mailing Address - Fax:
Practice Address - Street 1:230 ANCHOR WAY
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-1304
Practice Address - Country:US
Practice Address - Phone:516-564-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017944235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist