Provider Demographics
NPI:1265230361
Name:MITTEN, LOREN
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:MITTEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31605 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1062
Mailing Address - Country:US
Mailing Address - Phone:586-921-4137
Mailing Address - Fax:
Practice Address - Street 1:36358 GARFIELD RD STE 1
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-1161
Practice Address - Country:US
Practice Address - Phone:586-221-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist