Provider Demographics
NPI:1639214042
Name:MITCHELL, NICOLE SELINA (BS SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:SELINA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:BS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 W. CALLE CAJETA
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629
Mailing Address - Country:US
Mailing Address - Phone:520-977-0954
Mailing Address - Fax:
Practice Address - Street 1:597 W CALLE CAJETA
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-7900
Practice Address - Country:US
Practice Address - Phone:520-977-0954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL5279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist