Provider Demographics
NPI:1679552574
Name:MITCHELL, RHONDA J (SLP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:RHONDA
Other - Middle Name:J
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSP CCC-SLP
Mailing Address - Street 1:1207 HILLSIDE GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-8502
Mailing Address - Country:US
Mailing Address - Phone:404-375-4245
Mailing Address - Fax:770-635-8960
Practice Address - Street 1:1207 HILLSIDE GREEN WAY
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-8502
Practice Address - Country:US
Practice Address - Phone:404-375-4245
Practice Address - Fax:770-635-8960
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000956414AMedicaid
GA000956414BMedicaid