Provider Demographics
NPI:1467509588
Name:MITCHELL, CHARRON MICHELLE (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CHARRON
Middle Name:MICHELLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 AMERICAN WAY APT 609
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-4537
Mailing Address - Country:US
Mailing Address - Phone:703-200-6494
Mailing Address - Fax:
Practice Address - Street 1:250 AMERICAN WAY APT 609
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-4537
Practice Address - Country:US
Practice Address - Phone:703-200-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000477235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist