Provider Demographics
NPI:1770670754
Name:MITCHELL, KERI LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:LYNN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CHICKASAW DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-2210
Mailing Address - Country:US
Mailing Address - Phone:318-547-8623
Mailing Address - Fax:318-410-4351
Practice Address - Street 1:500 CHICKASAW DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-2210
Practice Address - Country:US
Practice Address - Phone:318-547-8623
Practice Address - Fax:318-410-4351
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3179235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist