Provider Demographics
NPI:1326546367
Name:MITZELFELT, LINDA (MA CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MITZELFELT
Suffix:
Gender:F
Credentials:MA CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 29TH ST
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-3010
Mailing Address - Country:US
Mailing Address - Phone:847-872-5455
Mailing Address - Fax:
Practice Address - Street 1:2800 29TH ST
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-3010
Practice Address - Country:US
Practice Address - Phone:847-872-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist