Provider Demographics
NPI:1366681223
Name:MITCHELL, JOSEPH WILLIAM
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 W BARRY AVE
Mailing Address - Street 2:APT. 17A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5453
Mailing Address - Country:US
Mailing Address - Phone:715-497-4416
Mailing Address - Fax:
Practice Address - Street 1:5304 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1838
Practice Address - Country:US
Practice Address - Phone:630-402-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst