Provider Demographics
NPI:1710283254
Name:FITCHETT, MIKAYLA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:FITCHETT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:
Other - Last Name:DAWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1010 W JASPER DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-1331
Mailing Address - Country:US
Mailing Address - Phone:254-781-7397
Mailing Address - Fax:
Practice Address - Street 1:1010 W JASPER DR
Practice Address - Street 2:SUITE 9
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-1331
Practice Address - Country:US
Practice Address - Phone:254-781-7397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist