Provider Demographics
NPI:1710381538
Name:MITIAS, RHONDA HUGGINS (SLP)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:HUGGINS
Last Name:MITIAS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5699 GETWELL RD
Mailing Address - Street 2:BUILDING H SUITE 1
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672
Mailing Address - Country:US
Mailing Address - Phone:662-470-4187
Mailing Address - Fax:662-391-4236
Practice Address - Street 1:5699 GETWELL RD
Practice Address - Street 2:BUILDING H SUITE 1
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672
Practice Address - Country:US
Practice Address - Phone:662-470-4187
Practice Address - Fax:662-391-4236
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X, 235Z00000X
MS180059103K00000X
MSA2851231H00000X
MSS3893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04852570Medicaid