Provider Demographics
NPI:1669173274
Name:MITCHELL, CARLY ALLISON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ALLISON
Last Name:MITCHELL
Suffix:
Gender:
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13674 COUNTY HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:GUIN
Mailing Address - State:AL
Mailing Address - Zip Code:35563-4410
Mailing Address - Country:US
Mailing Address - Phone:205-570-1257
Mailing Address - Fax:
Practice Address - Street 1:400 19TH ST E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-5416
Practice Address - Country:US
Practice Address - Phone:205-265-2210
Practice Address - Fax:205-512-2548
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL220064235Z00000X
AL5358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist