Provider Demographics
NPI:1700407442
Name:MITCHIN, AMY WYATT (SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:WYATT
Last Name:MITCHIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:6000 HAMPTON CTR STE B
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1748
Mailing Address - Country:US
Mailing Address - Phone:304-599-1500
Mailing Address - Fax:304-599-7800
Practice Address - Street 1:6000 HAMPTON CTR STE B
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1748
Practice Address - Country:US
Practice Address - Phone:304-599-1500
Practice Address - Fax:304-599-7800
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-2090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist