Provider Demographics
NPI:1902231681
Name:IRWIN, MITCH (MS, SLP-CFY)
Entity Type:Individual
Prefix:MR
First Name:MITCH
Middle Name:
Last Name:IRWIN
Suffix:
Gender:M
Credentials:MS, SLP-CFY
Other - Prefix:MR
Other - First Name:MITCHELL
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:394 BERGEN ST
Mailing Address - Street 2:APT. 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-4632
Mailing Address - Country:US
Mailing Address - Phone:515-490-2028
Mailing Address - Fax:
Practice Address - Street 1:394 BERGEN ST
Practice Address - Street 2:APT. 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-4632
Practice Address - Country:US
Practice Address - Phone:515-490-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist