Provider Demographics
NPI:1457796898
Name:MITCH, JAMES LEONARD (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEONARD
Last Name:MITCH
Suffix:
Gender:M
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2242
Mailing Address - Country:US
Mailing Address - Phone:541-683-1496
Mailing Address - Fax:
Practice Address - Street 1:2535 ADAMS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2242
Practice Address - Country:US
Practice Address - Phone:541-683-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist