Provider Demographics
NPI:1578708426
Name:MITCHELL, TAMMY (BA SLP-A)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:BA SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-1846
Mailing Address - Country:US
Mailing Address - Phone:941-807-2863
Mailing Address - Fax:
Practice Address - Street 1:808 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-1846
Practice Address - Country:US
Practice Address - Phone:941-807-2863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI14692355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant