Provider Demographics
NPI:1396222196
Name:MIKHAIL, JONATHAN ANDREW (AUD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ANDREW
Last Name:MIKHAIL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 S JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1936
Mailing Address - Country:US
Mailing Address - Phone:417-781-2311
Mailing Address - Fax:417-781-6477
Practice Address - Street 1:2311 S JACKSON AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1936
Practice Address - Country:US
Practice Address - Phone:417-781-2311
Practice Address - Fax:417-781-6477
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2018026637OtherSTATE OF MO, CERTIFICATE/LICENSE