Provider Demographics
NPI:1336721398
Name:MITCHELL, HALLEE (MS, RD LD)
Entity Type:Individual
Prefix:
First Name:HALLEE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS, RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 W BROADWAY APT 24304
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-7922
Mailing Address - Country:US
Mailing Address - Phone:618-972-4035
Mailing Address - Fax:
Practice Address - Street 1:400 N KEENE ST STE 118
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6626
Practice Address - Country:US
Practice Address - Phone:573-882-6972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered