Provider Demographics
NPI:1639445380
Name:MITCHELL, LINDA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
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 1:2726 VICTORY BLVD
Mailing Address - Street 2:# 2A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6370
Mailing Address - Country:US
Mailing Address - Phone:347-466-5234
Mailing Address - Fax:
Practice Address - Street 1:2726 VICTORY BLVD
Practice Address - Street 2:# 2A
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6370
Practice Address - Country:US
Practice Address - Phone:347-466-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021794235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021794OtherTHE UNIVERSITY OF THE STATE OF NEW YORK EDUCATION DEPARTMENT