Provider Demographics
NPI:1295463685
Name:MABILE, MITZI ELLEN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MITZI
Middle Name:ELLEN
Last Name:MABILE
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 1:13852 BADGER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-0494
Mailing Address - Country:US
Mailing Address - Phone:972-824-7771
Mailing Address - Fax:
Practice Address - Street 1:5515 OHIO DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-7002
Practice Address - Country:US
Practice Address - Phone:469-633-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist