Provider Demographics
NPI:1891312617
Name:MITCHELL, CASSIE M (PHD, RD)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7253 E CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-2070
Mailing Address - Country:US
Mailing Address - Phone:817-229-7698
Mailing Address - Fax:
Practice Address - Street 1:7253 E CATALINA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-2070
Practice Address - Country:US
Practice Address - Phone:817-229-7698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86173489133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered