Provider Demographics
NPI:1942665385
Name:MITCHELL, DAPHNE (BCBA)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 W FERDINAND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-1938
Mailing Address - Country:US
Mailing Address - Phone:773-816-0464
Mailing Address - Fax:
Practice Address - Street 1:5450 W FERDINAND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-1938
Practice Address - Country:US
Practice Address - Phone:773-816-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
1-20-42305103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst