Provider Demographics
NPI:1518228204
Name:MITCHELL, MICA ERIN CARTER (SLP)
Entity Type:Individual
Prefix:
First Name:MICA
Middle Name:ERIN CARTER
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MICA
Other - Middle Name:ERIN
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 LINEBERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-5517
Mailing Address - Country:US
Mailing Address - Phone:615-758-4888
Mailing Address - Fax:615-758-6188
Practice Address - Street 1:116 LINEBERRY BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-5517
Practice Address - Country:US
Practice Address - Phone:615-758-4888
Practice Address - Fax:615-758-6188
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist