Provider Demographics
NPI:1407088313
Name:MITCHELL, AMY SHERMAN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SHERMAN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 OAK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-7946
Mailing Address - Country:US
Mailing Address - Phone:910-554-8014
Mailing Address - Fax:
Practice Address - Street 1:207 OAK RIDGE LN
Practice Address - Street 2:
Practice Address - City:HOLLY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:28445-7946
Practice Address - Country:US
Practice Address - Phone:109-554-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist