Provider Demographics
NPI:1639160872
Name:MITCHELL, BRENDA C (MS,CCC,SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:C
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS,CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 WILLOW SPRING RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-4715
Mailing Address - Country:US
Mailing Address - Phone:717-540-3446
Mailing Address - Fax:717-540-3447
Practice Address - Street 1:2151 LINGLESTOWN RD
Practice Address - Street 2:SUITE 140
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9499
Practice Address - Country:US
Practice Address - Phone:717-540-3446
Practice Address - Fax:717-540-3447
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005382L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA251844378OtherDEVON HEALTH SERVICES
PA50020000OtherCAPITAL BLUE CROSS
PA1537904OtherGATEWAY
PA7112494OtherAETNA PPO/POS
PA3317925OtherAETNA HMO
PAMI530509OtherHIGHMARK BLUE SHIELD
PA01840158Medicaid